Confusable diagnoses · PANCE / PANRE

Subarachnoid Hemorrhage vs Migraine

Subarachnoid Hemorrhage and Migraine are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.

Subarachnoid Hemorrhage vs Migraine at a glance

  • Subarachnoid Hemorrhage: Bleeding into the subarachnoid space, usually from a ruptured saccular aneurysm.
  • Migraine: Recurrent primary headache disorder with unilateral throbbing pain, photophobia, nausea.
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Side-by-side comparison

FeatureSubarachnoid HemorrhageMigraine
At a glanceBleeding into the subarachnoid space, usually from a ruptured saccular aneurysm.Recurrent primary headache disorder with unilateral throbbing pain, photophobia, nausea.
Classic presentationThunderclap headache + meningismus + LOC. Hunt-Hess and World Federation of Neurosurgical Societies (WFNS) grading scales predict outcome.; Sudden severe…POUND mnemonic: Pulsatile, One-day duration (4-72 h), Unilateral, Nausea, Disabling — 4 of 5 features highly suggest migraine.; Prodrome (hours-days before):…
Workup / key labsSubarachnoid blood on CT in basal cisterns, sylvian fissure, or interhemispheric fissure; or xanthochromia on LP.; CBC, coagulation panel, BMP, troponin…ICHD-3 criteria: ≥5 attacks lasting 4-72 hours, with ≥2 of [unilateral, pulsating, moderate-severe, aggravated by activity] AND ≥1 of [nausea/vomiting,…
ImagingNon-contrast head CT within 6 h of symptom onset is ~100% sensitive (drops to ~85% at 24 h, ~50% at 1 week); Lumbar puncture if CT negative but clinical…Neuroimaging NOT routinely indicated for typical migraine with normal exam; MRI brain indicated for: red flags (SNOOP: Systemic symptoms/Secondary risk…
First-line treatmentABCs; intubate if GCS ≤8 or airway compromise; BP control: target SBP <160 (or MAP <110) until aneurysm secured — IV nicardipine, clevidipine, or labetalol;…Abortive: NSAIDs (ibuprofen 400-800 mg, naproxen 500 mg) for mild-moderate attacks; Triptan — sumatriptan 50-100 mg PO (also 6 mg SC, 20 mg nasal),…

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Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants.