[Headache simulating meningeal hemorrhage].

That migraine can present with a severe headache of sudden onset mimicking that of subarachnoid hemorrhage--the so-called "complicated migraine with meningeal manifestations" of Pearce and Foster--is not readily appreciated. Over the past three years, seven patients have been referred to us with a presumable diagnosis of subarachmoid hemorrage. In each one of these patients, the clinical features (an explosive headache, relapsing in three, and a normal neurological examination) together with appropriate laboratory investigations (cerebro-spinal fluid analysis, electroencephalography, echoencephalography, brain scan, arteriography, pneumoencephalography) have ruled out the diagnosis of subarachnoid hemorrhage, as well as less common causes of explosive headaches such as ball-valve tumors of the ventricular system, intra-cerebral hemorrhage, hemorrhage into a tumor. In three out of these seven patients, there was no history of migraine. Bening explosive headaches mimicking subarachnoid hemorrhage, occurring in patients with or without antecedents of migraine, are not as unusual as one might conclude from a review of the literature. Proper recognition of this syndrome is important since it might help to sort out those patients with explosive headaches who need not be submitted indiscriminately to risk-fraught procedures.