Thunderclap Headache in HIV Positive Patients: Aetiology, Clinical Findings and Long-Term Follow-Up of a Series of 5 Cases

Abstract

Background: Thunderclap headache is a severe headache of sudden onset that peaks within a few seconds. The aim of this study was to describe the clinical characteristics, etiologies and long-term prognosis of thunderclap headaches in HIV positive patients.
Patients and Methods: This was a 5-year retrospective study of thunderclap headaches in HIV positive patients with a long-term follow-up at the Neurology Unit of the Internal Medicine Department of the Douala General Hospital. All patients had a cerebral magnetic resonance imaging and cerebrospinal fluid analysis. Patients were followed-up at the out-patient department after hospitalization.
Results: 65 patients were recorded with thunderclap headaches over the study period, and 5 were infected with HIV type 1 (7, 69%). The mean age was 50, 8±15, 4 years. There were three females and the mean CD4 count was 328, 6±195, 8 cells/mm3. The aetiologies of thunderclap headache were one case each of subarachnoid haemorrhage, ischemic stroke, primary thunderclap headache, cryptoccocal meningitis and migraine without aura respectively. The mean duration of the out-patient follow-up was 17 months±10, 2 (1-25) months; 95% CI (5, 7-24). There was no relapse of thunderclap headache and the mortality rate was 20%.
Conclusion: Thunderclap headache in HIV positive patients occurs spontaneously and is independent of the level of CD4 count. The aetiologies are heterogeneous, and show no predominance of subarachnoid haemorrhage thus highlighting the important role of neuroimaging in the diagnosis of its cause.