Dr Sanan Akbar, Dr Yousaf Noor Ahmad, Dr Sohaib Salam
Objective: To find out the frequency, results after diagnose and follow up of those patients who attend Railway General Hospital Rawalpindi due to sudden thunderclap headache. Methodology: The duration of this study was from February 2019 to January 2020 conducted in Railway General Hospital Rawalpindi. A total subject of 22,000 reported to of which 128 patients appeared with acute sudden thunderclap headache. Among those patients, 78 (60%) female and 50 (39%) males with 15-80 years age (46±10 as mean age). Facilities included lab investigation, medical examination/treatment, ICUs for observation, and follow-up of patients. For intensive studies, brain/LP were properly examined with 1-month review after discharge. Results: After examining 120 cases, 15.60% patients (20) suffered from SAH (Subarachnoid haemorrhage), 5.40% patients (7) from cerebral infarction, 3.90% patients (5) from aseptic meningitis, and 3.90% patients (5) from Intra-cerebral Haematoma. Only 1.50% (2) patients reported with cerebral edema and 0.80% (1) case with venous sinus thrombosis. Patients with no findings/follow up 69.01% (88) were noted under idiopathic thunderclap headache. Similar <3 episodes were present in 25.79% (33) patients. Conclusion: Severe cases of Thunderclap Headache are common. All the above diseases are not uncommon and must be categorised either organic or benign headache. Patients suffering from such diseases be hospitalized for brain CT scan for further recommendation. KEYWORDS: Idiopathic Thunderclap Headache (ITH), Severe Thunderclap Headache (STH), Lumber Puncture (LP), Intensive Care Unit (ICU), Cerebral Venous Sinus Thrombosis (CVST).