To the Editor.
—Verweij and colleagues1 are to be complimented on their work reported in the September 1988 issue of the Archives. Neurologists and neurosurgeons regularly are confronted with patients who had had a recent sudden onset of an unusual headache, the patient having been told to take some aspirin (probably contraindicated if an aneurysm has ruptured) and return to the doctor's office or emergency room if symptoms persist. As fewer and fewer medical students get any exposure to neurosurgery, failure to recognize or suspect this "warning leak" can only increase in incidence.The early warning symptoms of a subarachnoid hemorrhage are well known.2 Of interest is the first description by Collier in 1931.3A lady who was touring in the country developed so severe a headache that she decided to return home, and drove her car from Liverpool to London without a break. I saw her immediately
Fox JL. Warning Headache in Aneurysmal Subarachnoid Hemorrhage. Arch Neurol. 1989;46(8):839. doi:10.1001/archneur.1989.00520440019005