Thunderclap headache: CT and lumbar puncture but occasionally more!

In considering thunderclap headache, the immediate need is to exclude the possibility of subarachnoid hemorrhage. Both our protagonists agree on this point, that the minimum required is to perform a plain brain CT and, if there is no evidence of hemorrhage, lumbar puncture. We agree with Moussouttas and Mayer that spectrophotometry to detect xanthochromia should be mandatory. It is at this point where many clinicians diverge in their …