Thunderclap headache and suspected SAH (adult UK pathway)
A source-linked educational visual of adult thunderclap headache assessment, CT timing, lumbar puncture and specialist escalation from NICE NG228.
Important safety note
This visual algorithm is an educational representation of published UK clinical guidance and is not a substitute for clinical judgement, local protocols, senior/specialist advice, or the original guideline. Verify current guidance before clinical use.
Scope and source
- Scope
- Adults with thunderclap headache or suspected aneurysmal subarachnoid haemorrhage in UK emergency care.
- Jurisdiction
- UK
- Primary guidance
- NICE NG228: Subarachnoid haemorrhage caused by a ruptured aneurysm
- Guidance last updated
- 2022-11-23
- Clinical reference reviewed
- 2026-09-08
- Review due
- 2027-03-08
Interactive clinical algorithm
This source-backed visual algorithm is available in the interactive page experience. Open the original guidance and the node notes before clinical use.
How to read this visual
- Read across the columns for the phases of the pathway; the swimlanes are who acts — Emergency team, Imaging and CSF testing, Neurosurgical and specialist care.
- Bold marks the dose, threshold or time limit that decides the next step; the rest of a label is context.
- Start with resuscitation and red-flag assessment before imaging.
- Open notes for CT timing, radiology reporting, CSF bilirubin and specialist transfer.
Clinical notes
- Do not delay escalation for clinical deterioration simply to complete an investigation sequence.
- Use local anticoagulation, lumbar-puncture, neurosurgical-transfer and aneurysmal-SAH protocols.
Sources
- NICE NG228: Subarachnoid haemorrhage caused by a ruptured aneurysm (NICE; 2022-11-23)
Open an editable reference copy
Create a personal educational copy. Verify the original guidance before clinical use.