Materiały źródłowe

• #1 Overview of thunderclap headache – UpToDate

  https://www.uptodate.com/contents/overview-of-thunderclap-headache

  Thunderclap headache (TCH) refers to a severe headache of sudden onset. Its explosive and unexpected nature is likened to a „clap of thunder.” Multiple etiologies may cause TCH. This topic will review the clinical presentation, etiologies, and diagnostic evaluation of TCH. […] A TCH is a very severe headache of abrupt onset that reaches its maximum intensity within one minute or less of onset. The key feature that differentiates TCH from other headaches is the rapidity with which it develops; extreme severity alone is insufficient. […] By definition, TCH is a very severe headache that begins abruptly and reaches maximum intensity within one minute or less of onset. Patients may present with TCH either in isolation or accompanied by additional symptoms and signs (eg, meningismus, fever, tinnitus, orthostatic worsening of headache, altered mental state, seizure, motor or sensory deficits, or cranial nerve palsies) that reflect the underlying cause. […] Given the serious and potentially life-threatening nature of underlying intracranial etiologies, TCH is a medical emergency requiring immediate evaluation.

• #1 Thunderclap Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560629/

  Patients presenting with a thunderclap headache (TCH) may describe their pain as the worst headache ever or worst headache of my life. […] TCH is often associated with a potentially fatal etiology, such as subarachnoid hemorrhage (SAH), and is considered a medical emergency, requiring a rapid, focused evaluation. […] According to the ICHD-3, Evidence that thunderclap headache exists as a primary disorder is poor: the search for an underlying cause should be both expedited and exhaustive. […] A focused history and neurologic examination will help differentiate TCH from other headache types, narrow the secondary TCH differential diagnoses, and guide the initial testing phase. […] Primary and secondary TCH diagnostic criteria are (1) severe head pain with abrupt onset, (2) pain reaching maximum intensity in less than one minute, (3) pain lasting at least 5 minutes, and (4) headache not better accounted for by another ICHD-3 diagnosis.

• #2 Thunderclap Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560629/

  Patients presenting with a thunderclap headache (TCH) may describe their pain as the worst headache ever or worst headache of my life. […] TCH is often associated with a potentially fatal etiology, such as subarachnoid hemorrhage (SAH), and is considered a medical emergency, requiring a rapid, focused evaluation. […] According to the ICHD-3, Evidence that thunderclap headache exists as a primary disorder is poor: the search for an underlying cause should be both expedited and exhaustive. […] A focused history and neurologic examination will help differentiate TCH from other headache types, narrow the secondary TCH differential diagnoses, and guide the initial testing phase. […] Primary and secondary TCH diagnostic criteria are (1) severe head pain with abrupt onset, (2) pain reaching maximum intensity in less than one minute, (3) pain lasting at least 5 minutes, and (4) headache not better accounted for by another ICHD-3 diagnosis.

• #3 Thunderclap Headaches | American Migraine Foundation

  https://americanmigrainefoundation.org/live-copy/resource-library/thunderclap-headaches/

  Thunderclap headaches come on quickly without warning and are extremely painful—and they can be a sign of something serious. Learn how to spot a thunderclap headache and what to do if you experience one. […] A thunderclap headache feels like a sudden, severe headache that comes on within less than a minute. This extremely abrupt onset and head pain unlike any you’ve experienced before can be a terrifying experience, and most often requires urgent medical attention. Although many times no cause is found, the first occurrence of a thunderclap headache can be a sign of something very serious. […] Thunderclap headaches are severe headaches coming on full force in less than a minute, lasting at least 5 minutes, and often appearing without any trigger. The pain may be felt anywhere in the head and may in some cases extend down the back of the neck.

• #4 4.4 Primary thunderclap headache – ICHD-3

  https://ichd-3.org/other-primary-headache-disorders/4-4-primary-thunderclap-headache/

  4.4 Primary thunderclap headache […] Previously used term: Benign thunderclap headache. […] Coded elsewhere: 4.1 Primary cough headache, 4.2 Primary exercise headache and 4.3 Primary headache associated with sexual activity can all present as thunderclap headache. When such headache is attributed uniquely to one of these triggers, it should be coded accordingly as one of these headache types. […] Description: High-intensity headache of abrupt onset, mimicking that of ruptured cerebral aneurysm, in the absence of any intracranial pathology. […] Diagnostic criteria: […] 1. Severe head pain fulfilling criteria B and C […] 2. Abrupt onset, reaching maximum intensity in <1 minute [...] 3. Lasting for ≥5 minutes [...] 4. Not better accounted for by another ICHD-3 diagnosis. [...] Notes:

• #5 4.4 Primary thunderclap headache – ICHD-3

  https://ichd-3.org/other-primary-headache-disorders/4-4-primary-thunderclap-headache/

  1. Thunderclap headache is frequently associated with serious vascular intracranial vascular disorders, particularly subarachnoid haemorrhage: it is mandatory to exclude this and a range of other such conditions including intracerebral haemorrhage, cerebral venous thrombosis, unruptured vascular malformation (mostly aneurysm), arterial dissection (intra- and extracranial), reversible cerebral vasoconstriction syndrome (RCVS) and pituitary apoplexy. Primary thunderclap headache should be a diagnosis of last resort, reached only when all organic causes have been demonstrably excluded. This implies normal brain imaging, including the brain vessels, and/or normal CSF. […] 2. Vasoconstrictions may not be observed in the early stage of RCVS. For this reason, probable primary thunderclap headache is not a diagnosis that should be made even temporarily. […] Comment: Evidence that thunderclap headache exists as a primary disorder is poor: the search for an underlying cause should be both expedited and exhaustive.

• #6 Thunderclap headache – GPnotebook

  https://gpnotebook.com/pages/neurology/thunderclap-headache

  A non-haemorrhagic „thunderclap” headache (TCH) is a diagnosis of exclusion made in patients whom present with severe headache but have a negative CT and LP. […] all patients with TCH should be investigated with at least a CT scan and MR angiography, since this type of headache is not a frequent benign recurrent headache disorder, and may represent a serious underlying process. […] TCH is defined by the ICHD-II as a severe intense headache which is of rapid onset mimicking a subarachnoid haemorrhage (SAH) from a ruptured aneurysm with maximum intensity being reached in less than a minute. […] diagnosed when no underlying cause is discovered. […] ICHD-II classification states that normal brain imaging and CSF are required before a diagnosis. […] Patients with a first presentation of thunderclap headache should be referred immediately to hospital for same day specialist assessment. […] primary TCH has a distinctive clinical and angiographic profile and must be distinguished from central nervous system vasculitis and SAH.

• #7 Thunderclap headaches – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/thunderclap-headaches/diagnosis-treatment/drc-20378366

  Thunderclap headaches are often diagnosed in an emergency room. However, if you call to set up an appointment with your own doctor, you might be referred immediately to a doctor who specializes in the brain and nervous system (neurologist). […] What tests do I need? […] Your doctor is likely to ask you questions, including: Have you had other thunderclap headaches? […] What, if anything, seems to improve your headaches? […] What, if anything, appears to worsen your headaches?

• #8 Thunderclap Headache: What It Is, Causes & Symptoms

  https://my.clevelandclinic.org/health/symptoms/17876-thunderclap-headaches

  Go to the emergency room if youre experiencing a thunderclap headache for the first time. Its urgent to determine if a dangerous condition is the underlying cause so it can be treated quickly if necessary. […] A healthcare provider will order tests to determine if a more serious medical condition is causing it.

• #8 Thunderclap Headache: What It Is, Causes & Symptoms

  https://my.clevelandclinic.org/health/symptoms/17876-thunderclap-headaches

  A thunderclap headache is a rare type of headache thats extremely painful and comes on suddenly. It can be a sign of blood vessel issues or bleeding in your brain. Because of this, a thunderclap headache requires immediate medical attention. […] Its important to seek medical attention immediately to rule out life-threatening causes of a thunderclap headache. […] A healthcare provider can order tests to determine what, if anything, is causing it. […] Since its impossible to know for certain if youre having a primary or secondary thunderclap headache, its important to seek immediate medical attention if you experience one. […] Thunderclap headaches are a medical emergency, and its important to assess them for an underlying cause. If healthcare providers find the cause, they tailor the treatment to address it.

• #9 Thunderclap Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560629/

  Although diagnostic algorithms vary slightly, emergent noncontrast head computed tomography (CT) is the recommended first step after the history and physical, primarily to assess for SAH. […] Diagnosis of SAH relies on noncontrast head CT, followed by LP if the CT findings are negative and the clinical suspicion is high. […] When LP is indicated, it should be performed as soon as possible after the noncontrast head CT. […] The absence of associated symptoms and a normal physical examination do not exclude a serious etiology of secondary TCH. […] There are only a few case reports on primary TCH treatment, and evidence supporting that TCH exists as a primary disorder is poor.

• #10 Thunderclap headaches – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/thunderclap-headaches/diagnosis-treatment/drc-20378366

  The following tests are commonly used to try to determine the cause of a thunderclap headache. […] CT scan of the head. CT scans take X-rays that create slice-like, cross-sectional images of your brain and head. A computer combines these images to create a full picture of your brain. Sometimes an iodine-based dye is used to augment the picture. […] Spinal tap (lumbar puncture). The doctor removes a small amount of the fluid that surrounds your brain and spinal cord. The cerebrospinal fluid sample can be tested for signs of bleeding or infection. […] MRI. In some cases, this imaging study might be done for further assessment. A magnetic field and radio waves are used to create cross-sectional images of the structures within your brain. […] Magnetic resonance angiography. MRI machines can be used to map the blood flow inside your brain in a test called a magnetic resonance angiography (MRA).

• #11 Thunderclap Headaches | American Migraine Foundation

  https://americanmigrainefoundation.org/live-copy/resource-library/thunderclap-headaches/

  In some cases, a thunderclap headache may be accompanied by fever, weakness, confusion, loss of vision or sensation, or changes in speech or thinking. If you experience any of these symptoms alongside a thunderclap headache, you should seek immediate medical attention. […] If a patient is evaluated promptly, the problem can often be diagnosed with a CAT scan and a spinal tap or lumbar puncture, in which a sample of spinal fluid is withdrawn from the back and analyzed for the presence of blood. Alternatively, MRI and MRA or CTA imaging may be used during the later stages of a headache. […] It is difficult to know whether or not a sudden, severe headache is a sign of a dangerous underlying condition. For this reason, all first-time thunderclap headaches should be dealt with by seeking immediate medical evaluation to look for signs of more serious problems.

• #12 Evaluating thunderclap headache – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33661161/

  Thunderclap headache (TCH) is an abrupt-onset of severe headache that needs to be thoroughly investigated because the most common secondary cause is subarachnoid hemorrhage (SAH). […] The most important update in the 2019 American College of Emergency Physicians guideline for evaluation of acute headache in the emergency department is that negative noncontrast brain computed tomography (CT) findings within 6 h from ictus essentially excludes SAH. Additionally, the updated guideline recommends that after a negative brain CT, CT angiogram is a reasonable alternative to lumbar puncture if clinical suspicion of an intracranial source of SAH is high. […] Awareness of the clinical features and application of diagnostic tools specific for different pathological conditions can facilitate the diagnostic workup.

• #13 Thunderclap Headaches – Symptoms, Causes,and Treatment

  https://www.webmd.com/migraines-headaches/thunderclap-headaches

  MRI. This imaging test is often used as a follow-up to a CT scan. It uses a magnetic field and radio waves to create cross-sectional images of the inside of your brain. […] Magnetic resonance angiography. MRI machines can be used to map the blood flow inside your brain in a test called a magnetic resonance angiography (MRA).

• #14 Thunderclap Headache: An Overview – Clinical Pain Advisor

  https://www.clinicalpainadvisor.com/features/thunderclap-headache-an-overview/

  In an interview with Neurology Advisor, Robert Cowan, MD, FAAN explains how thunderclap headache may be the only early warning sign of vascular changes or brain injury. […] Although thunderclap headache (TCH) is rare, it can indicate the presence of a serious underlying disorder and thus warrants immediate medical attention. […] The big question is whether this is a primary headache or a secondary headache due to subarachnoid hemorrhage or another serious condition, he told Neurology Advisor. […] Diagnosis of RCVS typically requires immediate magnetic resonance angiography (MRA) or CT angiogram (CTA), as the blood vessels may appear normal after the spasm has resolved. […] Any thunderclap headache accompanied by fever, weakness, loss of vision or sensation, or accompanied by confusion or changes in speech or thinking, needs immediate evaluation, Dr Tepper emphasized.

• #15

  https://journals.lww.com/continuum/fulltext/2015/08000/thunderclap_headache.13.aspx

  A thunderclap headache is a very severe headache that reaches its maximum intensity within 1 minute. Patients with thunderclap headache must be evaluated emergently and comprehensively to rule out underlying disorders that can be associated with high mortality and morbidity, determine the cause for the thunderclap headache, and initiate targeted therapy. This review presents an up-to-date summary on the clinical presentation, diagnostic evaluation, and causes of thunderclap headache. […] The urgent evaluation of the patient with thunderclap headache includes brain CT, followed by lumbar puncture if the brain CT is nondiagnostic. If a diagnosis is not reached following brain CT and lumbar puncture, brain MRI and imaging of the brain and cervical vasculature are indicated. […] Patients with thunderclap headache require an emergent and comprehensive evaluation to identify the underlying cause and to initiate appropriate therapy.

• #16 Thunderclap headache: when the risk of doing nothing is too high | Medicine Today

  https://medicinetoday.com.au/mt/2017/july/feature-article/thunderclap-headache-when-risk-doing-nothing-too-high

  A thunderclap headache is an uncommon presentation of headache but is important to recognise because it is often associated with serious vascular intracranial disorders, and should therefore be investigated urgently. Aneurysmal subarachnoid haemorrhage is the foremost consideration, and reversible cerebral vasoconstriction the next most common cause. The causes and diagnostic approach to patients with thunderclap headache are discussed. […] The cause of thunderclap headache should be considered to be aneurysmal subarachnoid haemorrhage until proven otherwise. […] The diagnostic work up involves urgent nonenhanced CT of the brain (with CT angiography if immediately available), then possibly a lumbar puncture, and then cerebral arterial and venous imaging with either MRI or CT if each preceding investigation has yielded a normal/negative result.

• #17 Thunderclap headache: when the risk of doing nothing is too high | Medicine Today

  https://medicinetoday.com.au/mt/2017/july/feature-article/thunderclap-headache-when-risk-doing-nothing-too-high

  Following the history and physical examination, all patients with thunderclap headache should be managed as a medical emergency to avoid potentially catastrophic consequences from SAH and other intracranial causes of the headache. […] The first investigation should be a brain CT scan to evaluate for SAH and other intracranial causes of thunderclap headache. […] A lumbar puncture is indicated if a brain CT scan or CT angiography does not reveal the aetiology of the thunderclap headache. […] Patients who have nondiagnostic brain CT scans and lumbar puncture results should be further evaluated with contrast-enhanced brain MRI and noninvasive vascular imaging of the head and neck (magnetic resonance angiography or CT angiography). […] About 70% of patients with SAH present with headaches as the main symptom, and about 50% of these present with thunderclap headache. SAH is found in up to 25% of patients with thunderclap headache. […] The diagnostic criteria for RCVS include thunderclap headache(s) with or without focal neurological deficits or seizures. […] Lumbar puncture analysis is typically normal in patients with RCVS.

• #18 Thunderclap headache – Wikipedia

  https://en.wikipedia.org/wiki/Thunderclap_headache

  A thunderclap headache is a headache that is severe and has a sudden onset. It is defined as a severe headache that takes seconds to minutes to reach maximum intensity. Although approximately 75% are attributed to „primary” headaches, the remainder are secondary to other causes, which can include some extremely dangerous acute conditions, as well as infections and other conditions. Usually, further investigations are performed to identify the underlying cause. […] The most important initial investigation is computed tomography of the brain, which is very sensitive for subarachnoid hemorrhage. If this is normal, a lumbar puncture is performed, as a small proportion of SAH is missed on CT and can still be detected as xanthochromia. […] If both investigations are normal, the specific description of the headache and the presence of other abnormalities may prompt further tests, usually involving magnetic resonance imaging (MRI). Magnetic resonance angiography (MRA) may be useful in identifying problems with the arteries (such as dissection), and magnetic resonance venography (MRV) identifies venous thrombosis. It is not usually necessary to proceed to cerebral angiography, a more precise but invasive investigation of the brain’s blood vessels, if MRA and MRV are normal.

• #19 Thunderclap Headaches: Symptoms, Causes, and Treatment

  https://www.healthline.com/health/thunderclap-headaches

  A thunderclap headache is a severe headache that starts suddenly. It doesnt gradually build in intensity. Instead, its an intense and very painful headache as soon as it starts. It can be a sign of a condition that can be life threatening. […] Its important that you seek medical attention if you think youre experiencing one. It may also have a benign cause thats not life threatening, but a doctor should still check it immediately to find out whats causing it. […] A thunderclap headache is most commonly a symptom of a subarachnoid hemorrhage, or bleeding in the brain, which can be life threatening if not treated quickly. The most common cause of this type of bleeding is a ruptured aneurysm in the brain. […] In some cases, a physical cause for your thunderclap headache may not be found. These types of thunderclap headaches are considered to be due to an idiopathic benign recurrent headache disorder. This headache can only be diagnosed after testing for all other causes.

• #20 Headaches Not to Miss Regardless of the Patient Population: Thunderclap Headache in the Emergency Department

  https://practicalneurology.com/diseases-diagnoses/alzheimer-disease-dementias/headaches-not-to-miss-regardless-of-the-patient-population-thunderclap-headache-in-the-emergency-department/32004/

  Most people presenting to the emergency department (ED) with headache are imaged with a noncontrast CT (NCCT) scan of the head. […] Providers typically are aware that thunderclap headache is a not-to-miss diagnosis and that thunderclap headache reaches severe intensity within 1 minute of onset. […] The following cases illustrate various clinical presentations of thunderclap headache and highlight associated signs and symptoms that should prompt further investigation beyond NCCT scans. […] Headache is the presenting symptom in approximately 70% of people with subarachnoid hemorrhage (SAH) and half of these individuals describe symptoms associated with thunderclap headache. SAH accounts for 25% of individuals presenting with thunderclap headache. […] Thunderclap headache is the sole manifestation of RCVS in 75% of cases, typically lasting 1 to 3 hours in duration.

• #21 Thunderclap headache • LITFL • Neurology library

  https://litfl.com/thunderclap-headache/

  Similar to primary thunderclap headaches, secondary thunderclap headaches are defined as sudden onset headaches that achieve maximal intensity within one minute. They are severe, occur suddenly, and persist for hours. Thunderclap headaches may be associated with photosensitivity, phonosensitivity, neck stiffness, and nausea with vomiting. […] Serious causes of secondary thunderclap headaches include subarachnoid haemorrhage (SAH), cervical artery dissection, stroke, and a hypertensive crisis. […] Since severe, abrupt onset headaches are often ominous, imaging in the form of magnetic resonance (MRI), computed tomography (CT), or MR angiography is usually performed to exclude secondary causes. Lumbar puncture may also be required. […] The thunderclap headache syndrome can also be a primary headache type. The primary headache is indistinguishable clinically from thunderclap headache secondary to a subarachnoid haemorrhage.

• #22 Thunderclap headache | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/thunderclap-headache?lang=us

  A thunderclap headache is a very sudden onset headache, and often described as being hit in the head with a baseball bat (cricket bat etc… presumably feel similar). Often it is described as the 'worst or first’ headache and 'explosive’ when severe. […] Classically it has been seen as a symptom of subarachnoid hemorrhage, however numerous other conditions can present in this fashion. These include: aneurysmal subarachnoid hemorrhage (SAH), perimesencephalic hemorrhage, parenchymal intracranial hemorrhage (ICH), cerebral venous thrombosis, pituitary apoplexy, carotid or vertebral dissection, reversible cerebral vasoconstrictions syndrome, intracranial infection, colloid cyst foramen of Monro obstruction, posterior fossa embolic event.

• #23 A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based? | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/1129-2377-15-49

  There are many potential causes of sudden and severe headache (thunderclap headache), the most important of which is aneurysmal subarachnoid haemorrhage. […] We sought to create a definitive list of causes, other than aneurysmal subarachnoid haemorrhage, using a systematic review. […] Our search identified over 21,000 titles, of which 1224 articles were scrutinized in full. […] A total of 119 causes were identified, of which 46 (38%) were not mentioned in published academic review articles. […] There is a need for an up to date population based description of cause of sudden and severe headache as the modern epidemiology of thunderclap headache may require updating in the light of research on cerebral vasoconstriction syndromes. […] We estimate completeness of ascertainment of causes using capture-recapture methods, and discuss the implications of using systematic review methods for lists of causation, paying attention to the issue of publication bias.

• #24 A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based? | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/1129-2377-15-49

  Our search strategy, executed in September 2009, identified 21,384 potential articles. […] Only one study had prospective, unselected population-based information on the incidence of Sudden Headache – estimating an annual incidence of 43 cases per 100,000 adults. […] This systematic review is therefore based upon a total of 219 English publications (213 original articles and 6 academic reviews). […] We identified 234 cases where vasoconstriction was a plausible or proven mechanism for headache. […] We present a comprehensive review of the literature on Sudden AND Severe Headache up to September 2009. […] Our understanding of causes of sudden and severe headache is evolving, yet we do not have a precise knowledge of trends or causes of this symptom in a population over time. […] An up to date population-based study could make an important contribution to our current knowledge of sudden and severe headache, specifically the true incidence and prognosis of vasoconstriction syndromes, and better assessment of the clinical features and prognosis of those with uncertain or unclassifiable headaches. […] This paper presents what we regard as a definitive list of associations of Sudden and Severe Headache.

• #25 Thunderclap headaches – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/thunderclap-headaches/symptoms-causes/syc-20378361

  Thunderclap headaches are uncommon, but they can warn of potentially life-threatening conditions usually having to do with bleeding in and around the brain. Seek emergency medical attention for a thunderclap headache. […] Seek immediate medical attention for any headache that comes on suddenly and severely. […] There’s no obvious cause for some thunderclap headaches. In other cases, a variety of potentially life-threatening conditions might be responsible, including: […] Diagnosis treatment.

• #26 Thunderclap Headaches: Symptoms, Causes, and Treatment

  https://www.healthline.com/health/thunderclap-headaches

  Only tests performed by a medical professional can determine which type of headache youre having. […] The first step in treating thunderclap headaches is to determine the cause. […] After a physical evaluation and gathering information about your symptoms, your doctor will usually start with a CT scan. CT scans will often be enough for your doctor to determine the cause. […] However, if it doesnt give them a clear cause, youll have additional tests done. […] Many causes of thunderclap headaches are life threatening if not diagnosed and treated promptly. […] You should seek medical help immediately when you first experience a severe and sudden headache of any kind. This type of headache can be a sign or symptom of a life threatening condition. […] If you seek medical help immediately when you experience a thunderclap headache, the cause can usually be effectively treated or managed. However, delaying medical treatment could be fatal. […] You should seek medical attention immediately if you experience a thunderclap headache, as its considered a medical emergency and may be a sign of a more serious underlying issue.

• #27 Thunderclap headaches: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/thunderclap-headaches

  Thunderclap headaches are severe headaches that develop rapidly. They can be a sign of a serious underlying medical condition, such as stroke. As such, they require immediate medical attention. […] A thunderclap headache is a severe headache with a rapid onset. While other types of headache build up slowly, thunderclap headaches tend to peak within 60 seconds. They typically occur without an obvious trigger. […] In some cases, a thunderclap headache may indicate a serious underlying medical condition that requires urgent treatment. As such, anyone who experiences this type of headache should seek immediate medical attention. […] Doctors often find diagnosing a thunderclap headache challenging. Although such headaches often signal a serious underlying medical condition, sometimes the cause can be relatively benign.

• #28 Diagnosing and Assessing Thunderclap Headache | MDedge Neurology

  https://www.mdedge9-ma1.mdedge.com/neurology/article/73054/headache-migraine/diagnosing-and-assessing-thunderclap-headache

  Thunderclap headache, a severe and explosive headache with a maximum intensity occurring within a minute of symptom onset, may have a more serious underlying pathology. […] Primary thunderclap headache can last from one hour to 10 days, and a diagnosis can be made only after the exclusion of another disorder, reported David Dolezil, PhD, Head of the Department of Neurology at Charles University in Prague, and colleagues. […] The first step of the diagnosis procedure was to obtain a history of present and previous headaches, other relevant medical history, and concomitant medication, as well as neurologic and physical examination, Dr. Dolezil stated. […] All patients with thunderclap headache syndrome underwent brain CT immediately, according to Dr. Dolezil, as did some patients with suspicion of ischemic stroke, subarachnoid hemorrhage, cerebral venous sinus thrombosis, and/or cerebral artery dissection.

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