What is the classic presentation for a subarachnoid hematoma?

The classic presentation for a subarachnoid hematoma is characterized by a "thunderclap headache," which is an abrupt and severe headache that often reaches maximal intensity within moments. This type of headache is typically described as the worst headache the individual has ever experienced and can arise suddenly, often with little to no warning.

The sudden onset is linked to the rapid increase in intracranial pressure or irritation of the meninges following bleeding into the subarachnoid space. This presentation is crucial for emergency medicine professionals to recognize, as subarachnoid hemorrhage can be a life-threatening condition that requires immediate evaluation and intervention.

The other manifestations, such as localized pain, nausea and vomiting, or gradual headache onset, can be associated with various other types of headaches or neurological conditions but are not classic indicators of subarachnoid hemorrhage. Localized pain may suggest specific structural causes, nausea and vomiting can accompany many types of headaches or neurological events, and a gradual headache onset is typically not indicative of a subarachnoid hematoma, which usually presents acutely.