Subarachnoid hemorrhage – causes and treatment

Find out why this serious brain bleed needs urgent medical attention plus how to support your recovery if it happens to you. 

What are the symptoms?

What causes it and who’s affected?

When to see a doctor 

Getting diagnosed

What are the treatments? 

Self-care tips to help your recovery

Subarachnoid hemorrhage – sometimes referred to as SAH – is bleeding on the surface of the brain that, without treatment, can cause brain damage, stroke, and even death. Find out more plus how to spot the signs. 


Although uncommon, a subarachnoid hemorrhage can happen to anyone. It’s a type of stroke and is often caused by a ruptured blood vessel ([aneurysm](https://www.livehealthily.com/health-library/conditions/aneurysm)) in the brain. 

Symptoms include a severe and debilitating headache that comes on suddenly. 

Once diagnosed with a subarachnoid hemorrhage, you will need emergency treatment to stop the bleeding, protect your brain, and save your life. 


## What are the symptoms?

The stand-out symptom of subarachnoid hemorrhage is a thunderclap headache, which is often described as the ‘worst headache of your life’. 

More than just a bad headache it is sudden, severe, and like nothing you’ve had before. 

It may also be accompanied by:

- nausea 
- vomiting
- blurred vision or seeing double
- a stiff neck
- sensitivity to light 
- stroke-like symptoms (slurred speech and weakness on 1 side of the body)
- loss of consciousness or convulsions (shaking).

__Get emergency medical help if you are experiencing these symptoms.__


Get help with this

## What causes it and who’s affected?

Anyone can get a subarachnoid hemorrhage, but it’s most common in the age group 45 to 70. Women are slightly more affected than men, as are black people, compared to other ethnicities. [1]

A subarachnoid hemorrhage is usually caused by a burst blood vessel (ruptured aneurysm) in the brain. This is due to a bulge caused by a weakness in the blood vessel wall. The pressure of blood passing through this weak vessel causes the area to bulge, and it can then burst.

There may not be any signs you are about to have a subarachnoid hemorrhage but it may happen due to a physical exertion – for example, coughing or lifting something heavy.

Certain things can increase the chance of having an aneurysm, such as:

- smoking
- high blood pressure
- a family history of aneurysms
- health problems such as [polycystic kidney disease](https://www.livehealthily.com/health-library/conditions/autosomal-dominant-polycystic-kidney-disease) or connective tissue conditions 
- drinking too much alcohol
- drug abuse
- a serious head injury.  

Most brain aneurysms don’t rupture, but if they’re found early then it’s possible to have a procedure to prevent risk of a subarachnoid hemorrhage.

Trauma to the head or blood vessel problems can also cause a subarachnoid hemorrhage, but this is less common.


## When to see a doctor 

A subarachnoid hemorrhage is a medical emergency and needs urgent treatment in hospital. 

Symptoms will usually come on suddenly and can be fatal without quick diagnosis and treatment. 

Serious complications can include brain damage because the brain’s blood supply is reduced, and the condition can be fatal.  

Go straight to the emergency room if you or someone you know shows signs of subarachnoid hemorrhage.


## Getting diagnosed

To diagnose a subarachnoid hemorrhage you will need various tests to check for bleeding in the brain. 

You may need to have one or more of these:

- CT scan
- MRI scan
- angiography
- lumbar puncture (if the bleeding is hard to detect on scans). 

Once diagnosed you will need urgent treatment.


## What are the treatments? 

Treatment will target the [cause of the bleed](https://www.livehealthily.com/health-library/conditions/subarachnoid-haemorrhage#causes), usually an aneurysm and try to prevent complications, such as brain damage. 

Medication options can include:

- codeine or morphine – strong pain relief to help manage headaches and other symptoms
- antiemetics or anticonvulsants – for seizures or sickness 
- nimodipine – used to increase the blood flow to injured brain tissue and prevent complications.

Surgery may also be required to repair the aneurysm and stop bleeding in the brain.

Depending on where the aneurysm is and your health status, surgery may include:

- coiling –  also known as endovascular embolization, this seals off the aneurysm using tiny coils
- clipping – also known as a craniotomy, this uses a tiny clip to seal off the aneurysm. 

Whatever treatment you have, you will need to be closely monitored afterward for complications that can arise. These can include:

- bleeding
- hydrocephalus (fluid on the brain)
- brain damage
- [epilepsy](https://www.livehealthily.com/health-library/conditions/epilepsy)
- [fatigue](https://www.livehealthily.com/health-library/symptoms/types-of-headache)
- headaches
- [insomnia](https://www.livehealthily.com/health-library/conditions/insomnia)
- vision problems. 

Recovery can be slow and you may also need physical, speech or other therapy to help. 


## Self-care tips to help your recovery
If you do experience a subarachnoid hemorrhage it can be a long road to recovery. 

However, the following steps may help you get stronger physically and mentally along the way – and could even minimize your risk of further setbacks or complications:

- get plenty of rest
- quit smoking 
- maintain a healthy blood pressure
- follow as healthy a lifestyle as you are able to
- expect good days and bad days
- take painkillers for headaches
- stay hydrated – avoid caffeine and alcohol 
- have physical therapy to help with mobility
- avoid driving – until you are signed off as safe to do so
- talk to someone – see below for support groups.  

### Where to get support

These professional organizations can help you come to terms with your experience and support your recovery:

- [Stroke Association (UK)](https://www.stroke.org.uk/)
- [Headway (UK)](https://www.headway.org.uk)
- [Brain Aneurysm Foundation (US)](https://www.bafound.org)
- [American Stroke Association (US)](https://www.stroke.org/)


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References

Juliet Blank

Jo Wheatley

Dr Ewan O'Farrell

Article information

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