NEURALGIA DE ARNOLD
Sentinel headache: warning sigh of the subarachnoid hemorrhage from intracranial aneurysm rupture. Headaches are a highly prevalent complaint in the world. Among many causes of headaches, the subarachnoid hemorrhage due to aneurysm rupture is one of the most important, because of the high rate of morbidity and mortality. About one third of the patients with subarachnoid hemorrhage due to an aneurysm rupture present complaints of an unusual sudden severe intensity headache - sentinel headache - preceding hours, days, weeks or months the subarachnoid hemorrhage. We studied 50 patients with aneurysmal subarachnoid hemorrhage from April to December, 2005. Nine out of the 50 patients (18.4%) presented sentinel headache, and a mean of 17.2 days was registered between the initial sentinel headache and the thunderclap headache leading the the diagnosis of intracranial subarachnoid hemorrhage. Among the nine patients referring sentinel headache four were evaluated in a health care units and five used home analgesic drugs without medical assistance. We concluded that the sentinel headache is a warning sign still unrecognized by patients and physicians.