Subarachnoid hemorrhage means bleeding into the space around the brain into the cerebrospinal fluid. While this can occur with trauma to the head, it can happen spontaneously due to the rupture of an intracranial aneurysm. An intracranial aneurysm is an abnormal bulging of the wall of an artery that feeds the brain. These weakened blood vessels have a tendency to rupture and bleed. This type of bleeding typically causes a sudden-onset of severe headache.
Most patients describe it as the “worst headache of my life.” It comes on very suddenly and is usually of a stabbing quality. It can be accompanied by nausea, vomiting, seizures, stiff, painful neck and/or a depressed level of consciousness. In severe bleeds it can even lead to coma or sudden death. In patients who have a history of chronic headaches, such as migraines or cluster headaches, they will generally say that the character of this headache is different. Therefore, a sudden, intense, new headache, particularly if associated with any of the other symptoms, should be considered a ruptured aneurysm until proven otherwise. An aneurysm rupture, like bacterial meningitis above, is generally a medical emergency. An aneurysm which has ruptured is at increased risk of re-rupture. Often the second rupture is more severe and more devastating than the first. Again, this is a rare cause of headache, but a potentially deadly one.
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