Bóle głowy typu „thunderclap” to bóle, które pojawiają się nagle i są bardzo bolesne. mogą być objawem krwawienia w mózgu.
Epidemiologia

Bóle głowy typu thunderclap charakteryzują się nagłym początkiem i osiągnięciem maksymalnego nasilenia w czasie krótszym niż 1 minuta, trwając minimum 5 minut, i często występują bez wyraźnego czynnika wyzwalającego. Epidemiologicznie są rzadkie, z roczną zapadalnością około 43/100 000 osób dorosłych, a w populacji pediatrycznej stanowią 0,8% przypadków zgłaszających się na oddział ratunkowy. Wśród przyczyn wtórnych najczęściej występuje krwotok podpajęczynówkowy (SAH) u 11-25% pacjentów, a także odwracalny zespół zwężenia naczyń mózgowych (RCVS) (8-45%), rozwarstwienie tętnicy szyjnej (20%), zakrzepica zatok żylnych (2-16%), nadciśnienie śródczaszkowe (15%) oraz zapalenie opon mózgowo-rdzeniowych (2%). Diagnostyka powinna obejmować CT głowy w ciągu 12 godzin od wystąpienia objawów, punkcję lędźwiową, MRI oraz badania naczyniowe, zgodnie z wytycznymi ICHD-3. Narzędzie Ottawa SAH Rule wykazuje 100% czułość i 13,6-15,3% swoistość w wykrywaniu SAH u pacjentów z bólem typu thunderclap.

  1. Epidemiologia bólów głowy typu „thunderclap”
    1. Występowanie bólu głowy typu thunderclap w populacji pediatrycznej
    2. Związek z płcią i wiekiem
  2. Nadzór nad bólami głowy typu thunderclap
    1. Badania diagnostyczne i wytyczne postępowania
    2. Przyczyny bólu głowy typu thunderclap
    3. Nadzór i ocena ryzyka
    4. Znaczenie dla zdrowia publicznego
  3. Systemy nadzoru i monitorowania bólu głowy typu thunderclap
    1. Ocena zgodności z wytycznymi
    2. Międzynarodowe badania i współpraca
    3. Prognozy i wyzwania w nadzorze
    4. Kolejne rozdziały

Epidemiologia bólów głowy typu „thunderclap”

Bóle głowy typu „thunderclap” to bóle, które pojawiają się nagle i są bardzo bolesne. mogą być objawem krwawienia w mózgu. Charakteryzują się nagłym początkiem, osiągając maksymalne nasilenie w czasie krótszym niż jedna minuta, trwają minimum 5 minut i często pojawiają się bez wyraźnego czynnika wyzwalającego12.

Według danych epidemiologicznych, częstość występowania bólów głowy typu thunderclap jest relatywnie niska. Badania populacyjne wskazują, że roczna zapadalność wynosi około 43 przypadki na 100 000 mieszkańców powyżej 18 roku życia34. To jedyna wiarygodna estymacja oparta na badaniu podgrupy populacji szwedzkiej5. Podobne dane przytaczane są w innych źródłach, potwierdzając, że jest to rzadkie schorzenie6.

Badanie populacyjne przeprowadzone we Włoszech wykazało, że częstość występowania bólów głowy typu thunderclap w ciągu całego życia wynosi 0,3% u mężczyzn i kobiet w wieku 55-94 lat7. Inne źródła podają, że mniej niż 0,3% populacji doświadczy tego typu bólu głowy w ciągu życia8.

Występowanie bólu głowy typu thunderclap w populacji pediatrycznej

Bóle głowy typu thunderclap w populacji pediatrycznej są uważane za bardzo rzadkie, chociaż dane na ten temat są ograniczone. W niedawnym retrospektywnym badaniu obejmującym dzieci i młodzież w wieku 6-18 lat zgłaszających się na pediatryczny oddział ratunkowy, bóle głowy typu thunderclap zdiagnozowano u 19 z 2290 (0,8%) pacjentów9. Przypadki zwężenia naczyń mózgowych” class=”to-tag” data-termid=”69124″>odwracalnego zespołu zwężenia naczyń mózgowych (RCVS), który może powodować bóle głowy typu thunderclap, opisywano również w populacji dziecięcej, ale głównie jako pojedyncze przypadki lub małe serie przypadków10.

Związek z płcią i wiekiem

Dane dotyczące związku między bólami głowy typu thunderclap a płcią są niejednoznaczne. W przypadku niektórych przyczyn tych bólów, takich jak zakrzepica zatok żylnych mózgu, obserwuje się przewagę kobiet. Badanie ISCVT (International Study on Cerebral Venous and Dural Sinuses Thrombosis) wykazało, że około 78% przypadków zakrzepicy zatok żylnych mózgu występuje u osób poniżej 50 roku życia11.

W przypadku odwracalnego zespołu zwężenia naczyń mózgowych (RCVS), duża seria przypadków u dorosłych wykazała, że schorzenie to najczęściej dotyka kobiety w średnim wieku12. Natomiast przegląd pacjentów pediatrycznych z RCVS wykazał przewagę płci męskiej13.

Nadzór nad bólami głowy typu thunderclap

Ze względu na potencjalnie zagrażające życiu przyczyny, bóle głowy typu thunderclap wymagają natychmiastowej oceny medycznej i są uważane za stan nagły14. Kluczową cechą odróżniającą bóle głowy typu thunderclap od innych bólów głowy jest szybkość, z jaką się rozwijają – samo ekstremalne nasilenie nie jest wystarczające do rozpoznania15.

Badania diagnostyczne i wytyczne postępowania

Międzynarodowa Klasyfikacja Bólów Głowy (ICHD-3) zaleca podejście diagnostyczne dla bólów głowy typu thunderclap, obejmujące tomografię komputerową (CT), punkcję lędźwiową (LP), badania naczyniowe i obrazowanie metodą rezonansu magnetycznego (MRI)16.

W przypadku pacjentów zgłaszających się z bólem głowy typu thunderclap do oddziału ratunkowego, zaleca się wykonanie tomografii komputerowej głowy w ciągu 12 godzin od wystąpienia objawów17. Około 99,3% pacjentów z krwotokiem podpajęczynówkowym (SAH) przechodzi badanie CT w ciągu 6 godzin od przybycia na oddział ratunkowy18.

Badanie Ottawa SAH Rule jest narzędziem decyzyjnym, które zostało prospektywnie zwalidowane. Reguła Ottawa SAH wykazała 100% czułość i 13,6-15,3% swoistość w kolejnych badaniach walidacyjnych19.

Jednakże, badania wskazują, że częstość wykonywania neuroobrazowania nie jest zgodna z międzynarodowymi wytycznymi, co sugeruje potencjalną potrzebę dalszej pracy nad standaryzacją20.

Przyczyny bólu głowy typu thunderclap

Bóle głowy typu thunderclap mogą być klasyfikowane jako pierwotne (idiopatyczne) lub wtórne (związane z określoną przyczyną). Szacuje się, że około 75% bólów głowy typu thunderclap jest przypisywanych do „pierwotnych” przyczyn: zaburzenia bólu głowy, niespecyficzny ból głowy, idiopatyczny ból głowy typu thunderclap lub nieokreślone zaburzenie bólu głowy21. Pozostałe 25% przypisuje się przyczynom wtórnym, takim jak problemy naczyniowe, infekcje i różne inne stany22.

Najczęstszą przyczyną wtórnych bólów głowy typu thunderclap jest krwotok podpajęczynówkowy (SAH), który występuje u 11-25% pacjentów z bólem głowy typu thunderclap2324. Kolejne najczęstsze przyczyny to:

  • Odwracalny zespół zwężenia naczyń mózgowych (RCVS) – szacuje się, że jest przyczyną 8-45% bólów głowy typu thunderclap, w których wykluczono SAH25. Ból głowy typu thunderclap jest jedynym objawem RCVS w 75% przypadków, zwykle trwającym 1-3 godziny26.27
  • Rozwarstwienie tętnicy szyjnej – ból głowy typu thunderclap występuje u 20% pacjentów z rozwarstwieniem tętnicy szyjnej28.29
  • Zakrzepica żył i zatok żylnych mózgu – ból głowy typu thunderclap występuje u 2-16% pacjentów z zakrzepicą żył i zatok żylnych mózgu30.31
  • Nadciśnienie śródczaszkowe – ból głowy typu thunderclap występuje u 15% pacjentów z nadciśnieniem śródczaszkowym32.
  • Zapalenie opon mózgowo-rdzeniowych – bakteryjne lub wirusowe zapalenie opon mózgowo-rdzeniowych jest przyczyną bólu głowy typu thunderclap u 2% pacjentów33. Prospektywne badanie pacjentów z bólem głowy typu thunderclap wykazało, że 2,7% miało etiologię zakaźną34.

Nadzór i ocena ryzyka

Każdy pacjent z bólem głowy typu thunderclap musi być traktowany tak, jakby miał zagrażający życiu stan wewnątrzczaszkowy35. Biorąc pod uwagę poważny i potencjalnie zagrażający życiu charakter podstawowych etiologii wewnątrzczaszkowych, ból głowy typu thunderclap jest stanem nagłym wymagającym natychmiastowej oceny36.

Niepowodzenie w dokładnym i szybkim badaniu pacjentów z bólem głowy typu thunderclap może prowadzić do błędnej diagnozy z wynikającymi z tego złymi wynikami z powodu ponownego krwawienia, wczesnego wodogłowia lub skurczu naczyń. Błędnie zdiagnozowani pacjenci zazwyczaj wydają się mniej chorzy i nie mają deficytów neurologicznych; błędna diagnoza wynika z braku zrozumienia zakresu możliwych prezentacji pacjentów z SAH i nieprzeprowadzenia CT lub LP37.

Znaczenie dla zdrowia publicznego

Bóle głowy typu thunderclap, choć rzadkie, mają istotne znaczenie dla zdrowia publicznego ze względu na ich potencjalnie poważne konsekwencje. Krwotok podpajęczynówkowy, który jest najczęstszą przyczyną wtórnych bólów głowy typu thunderclap, ma średni wskaźnik śmiertelności wynoszący 51%38.

Około 13% udarów to udary krwotoczne, według American Stroke Association39. Ponad 30% pacjentów z udarem rozwija krwotok podpajęczynówkowy40.

Świadomość charakterystycznych cech bólu głowy typu thunderclap wśród pracowników służby zdrowia i ogółu społeczeństwa jest kluczowa dla wczesnego rozpoznania i leczenia potencjalnie zagrażających życiu stanów. Ból głowy typu thunderclap z towarzyszącą gorączką, osłabieniem, utratą wzroku lub czucia, lub z dezorientacją bądź zmianami w mowie lub myśleniu, wymaga natychmiastowej oceny41.

Systemy nadzoru i monitorowania bólu głowy typu thunderclap

Istnieje potrzeba aktualizacji epidemiologii bólu głowy typu thunderclap w świetle badań nad zespołami zwężenia naczyń mózgowych42. Przegląd systematyczny przeprowadzony w 2009 roku zidentyfikował 21 384 potencjalnych artykułów dotyczących nagłego i ostrego bólu głowy43.

Szacuje się, że przegląd ten może być kompletny w 98%, służąc jako punkt odniesienia dla klinicystów i badaczy44.

Ocena zgodności z wytycznymi

Badania retrospektywne oceniające zgodność z wytycznymi w zarządzaniu bólem głowy typu thunderclap są prowadzone w różnych ośrodkach medycznych. Przykładem jest badanie przeprowadzone w King Abdullah Medical City Specialist Hospital (KAMC) w Mekce, które oceniało przestrzeganie wytycznych ICHD-3 i oceniało charakterystykę demograficzną, cechy kliniczne i wyniki pacjentów zgłaszających się na oddział ratunkowy z bólem głowy typu thunderclap45.

Badanie to wykazało, że większość pacjentów (91,3%) została zdiagnozowana ze stanami krwotocznymi, przy czym SAH był najbardziej rozpowszechniony (85,5%), co jest zgodne z istniejącą literaturą wskazującą SAH jako główną przyczynę bólu głowy typu thunderclap46.

Międzynarodowe badania i współpraca

Międzynarodowe badania kohortowe, takie jak ISCVT (International Study on Cerebral Venous and Dural Sinuses Thrombosis), dostarczają cennych informacji na temat zakrzepicy zatok żylnych mózgu, która może się przejawiać jako ból głowy typu thunderclap47.

Inne międzynarodowe badania wieloośrodkowe obserwacyjne kohortowe wykazały, że ból głowy typu thunderclap zgłaszany do oddziału ratunkowego jest związany z wyższym ryzykiem poważnej patologii wewnątrzczaszkowej, w tym SAH, chociaż większość pacjentów z tego typu bólem głowy miała łagodną przyczynę48.

Prognozy i wyzwania w nadzorze

Istnieje potrzeba poprawy systemów nadzoru i monitorowania bólu głowy typu thunderclap, zwłaszcza w krajach rozwijających się, gdzie dane są ograniczone. Niedawne badanie z Paryża we Francji sugeruje, że 1,5% wszystkich pacjentów z bólem głowy może mieć ból głowy typu thunderclap49.

Wyzwaniem w nadzorze nad bólem głowy typu thunderclap jest to, że pierwotny ból głowy typu thunderclap jest diagnozą z wykluczenia, stawianą dopiero po demonstracyjnym wykluczeniu wszystkich przyczyn organicznych. Oznacza to normalne obrazowanie mózgu, w tym naczyń mózgowych, i/lub normalny płyn mózgowo-rdzeniowy50.

Ponadto, zwężenia naczyń mogą nie być widoczne we wczesnym stadium RCVS. Z tego powodu, prawdopodobny pierwotny ból głowy typu thunderclap nie jest diagnozą, która powinna być stawiana nawet tymczasowo51.

Ból głowy typu thunderclap pozostaje ważnym wyzwaniem diagnostycznym i klinicznym. Ze względu na jego potencjalnie poważne konsekwencje, ważne jest, aby pracownicy służby zdrowia byli świadomi jego cech charakterystycznych i odpowiednio postępowali z pacjentami, którzy zgłaszają się z takimi objawami.

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  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Thunderclap Headaches | American Migraine Foundation
    https://americanmigrainefoundation.org/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.
  • #2 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:
  • #3 Thunderclap Headache – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK560629/
    A systematic literature review reported poor population-based data to accurately identify the true incidence and prevalence of thunderclap headaches. The authors determined that the only estimate of a population-based incidence is from the study of a subset of a Swedish population. The incidence is reportedly 43 per 100,000 inhabitants older than 18 years annually. […] A population-based study in Italy showed a 0.3% lifetime prevalence of TCH in men and women aged 55 to 94. […] TCH in the pediatric population is considered very rare, but data are limited. In a recent retrospective study of children and adolescents aged 6 to 18 years presenting to a pediatric emergency department, TCH was diagnosed in 19 out of 2290 (0.8%) of the included patients. […] In patients presenting with a TCH, subarachnoid hemorrhage is found in 11 to 25% and other intracranial hemorrhages in 5 and 10%. […] TCH is the presenting symptom in 20% of patients with cervical artery dissection, 2 to 16% with cerebral venous thrombosis, 15% with intracranial hypotension, and 2% with bacterial or viral meningitis.
  • #4 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. […] There is only one population-based estimate of the incidence of sudden and severe headache at 43 cases per 100,000. […] 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. […] 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. […] Our review collates a large number of published causes of sudden and severe headache and may serve as a benchmark for clinicians and researchers alike, as we estimate that our review may be 98% complete.
  • #5 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. […] There is only one population-based estimate of the incidence of sudden and severe headache at 43 cases per 100,000. […] 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. […] 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. […] Our review collates a large number of published causes of sudden and severe headache and may serve as a benchmark for clinicians and researchers alike, as we estimate that our review may be 98% complete.
  • #6 Thunderclap headache – Wikipedia
    https://en.wikipedia.org/wiki/Thunderclap_headache
    Incidence of thunderclap headache has been estimated at 43 per 100,000 people every year. Approximately 75% are attributed to „primary” headaches: headache disorder, non-specific headache, idiopathic thunderclap headache or uncertain headache disorder. The remainder is attributed to secondary causes: vascular problems, infections and various other conditions. […] The most important of the secondary causes are subarachnoid hemorrhage, cerebral venous sinus thrombosis, and dissection of an artery in the neck.
  • #7 Thunderclap Headache – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK560629/
    A systematic literature review reported poor population-based data to accurately identify the true incidence and prevalence of thunderclap headaches. The authors determined that the only estimate of a population-based incidence is from the study of a subset of a Swedish population. The incidence is reportedly 43 per 100,000 inhabitants older than 18 years annually. […] A population-based study in Italy showed a 0.3% lifetime prevalence of TCH in men and women aged 55 to 94. […] TCH in the pediatric population is considered very rare, but data are limited. In a recent retrospective study of children and adolescents aged 6 to 18 years presenting to a pediatric emergency department, TCH was diagnosed in 19 out of 2290 (0.8%) of the included patients. […] In patients presenting with a TCH, subarachnoid hemorrhage is found in 11 to 25% and other intracranial hemorrhages in 5 and 10%. […] TCH is the presenting symptom in 20% of patients with cervical artery dissection, 2 to 16% with cerebral venous thrombosis, 15% with intracranial hypotension, and 2% with bacterial or viral meningitis.
  • #8 Decoding Thunderclap Headaches: Causes and Solutions – Virtual Headache Specialist
    https://virtualheadachespecialist.com/thunderclap-headaches-explained/
    Thunderclap headaches are not common in individuals in developed countries, such as the United States. In fact, they happen to about 43 out of 100,000 adults. This headache requires emergent evaluation at the nearest emergency department for testing and evaluation, especially the first time that it occurs. […] Thunderclap headache is a medical emergency requiring an emergency evaluation by a physician, preferably by calling 911 and having an ambulance take you to the emergency department. […] According to the National Institute of Health, infections of the brain are responsible for about 7% of thunderclap headaches. […] The prevalence of thunderclap headaches is quite low. Less than .3% of people will experience a thunderclap headache during their lifetime. Additionally, lifetime prevalence of thunderclap headaches in emergency room patients is less than 6%.
  • #9 Thunderclap Headache – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK560629/
    A systematic literature review reported poor population-based data to accurately identify the true incidence and prevalence of thunderclap headaches. The authors determined that the only estimate of a population-based incidence is from the study of a subset of a Swedish population. The incidence is reportedly 43 per 100,000 inhabitants older than 18 years annually. […] A population-based study in Italy showed a 0.3% lifetime prevalence of TCH in men and women aged 55 to 94. […] TCH in the pediatric population is considered very rare, but data are limited. In a recent retrospective study of children and adolescents aged 6 to 18 years presenting to a pediatric emergency department, TCH was diagnosed in 19 out of 2290 (0.8%) of the included patients. […] In patients presenting with a TCH, subarachnoid hemorrhage is found in 11 to 25% and other intracranial hemorrhages in 5 and 10%. […] TCH is the presenting symptom in 20% of patients with cervical artery dissection, 2 to 16% with cerebral venous thrombosis, 15% with intracranial hypotension, and 2% with bacterial or viral meningitis.
  • #10 Reversible Cerebral Vasoconstriction Syndrome Presenting with Thunderclap Headache in a Child
    https://www.annchildneurol.org/journal/view.php?number=1301
    Reversible cerebral vasoconstriction syndrome (RCVS) is a clinical and radiological diagnosis characterized by the acute onset of headache, multiple constrictions of several cerebral blood vessels, and remission within 3 months. […] Thunderclap headache, which usually lasts for 1 to 3 hours, is a typical symptom accompanying RCVS, and focal neurologic deficits may also occur due to hemorrhages, infarcts, and even posterior reversible encephalopathy syndrome (PRES). […] Only small case series and individual cases of RCVS have been reported in children. […] RCVS is characterized by a thunderclap headache with or without neurological deficits, normal or near-normal CSF analysis, cerebral artery stenosis, or multifocal segmental areas of vasoconstriction, which generally resolve within a few weeks.
  • #11 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 ISCVT (International Study on Cerebral Venous and Dural Sinuses Thrombosis) found that approximately 78% of cases occurred in people younger than 50. […] 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.
  • #12 Reversible Cerebral Vasoconstriction Syndrome Presenting with Thunderclap Headache in a Child
    https://www.annchildneurol.org/journal/view.php?number=1301
    RCVS has been well-studied in adult patients. […] A large adult case series showed that RCVS commonly affects middle-aged women. […] In contrast, a review of pediatric RCVS patients reported a male predominance. […] Brain MRI and MRA should be performed for children with severe and recurrent thunderclap headaches, the most common symptom in RCVS. […] Most patients with RCVS have a good prognosis, but clinical follow-up is necessary in consideration of neurological complications.
  • #13 Reversible Cerebral Vasoconstriction Syndrome Presenting with Thunderclap Headache in a Child
    https://www.annchildneurol.org/journal/view.php?number=1301
    RCVS has been well-studied in adult patients. […] A large adult case series showed that RCVS commonly affects middle-aged women. […] In contrast, a review of pediatric RCVS patients reported a male predominance. […] Brain MRI and MRA should be performed for children with severe and recurrent thunderclap headaches, the most common symptom in RCVS. […] Most patients with RCVS have a good prognosis, but clinical follow-up is necessary in consideration of neurological complications.
  • #14 Overview of thunderclap headache – UpToDate
    https://www.uptodate.com/contents/overview-of-thunderclap-headache
    INTRODUCTION […] 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 (table 1). 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.
  • #15 Overview of thunderclap headache – UpToDate
    https://www.uptodate.com/contents/overview-of-thunderclap-headache
    INTRODUCTION […] 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 (table 1). 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.
  • #16 Thunderclap headache management among Emergency Department visitors in tertiary care center in Makkah City: Retrospective cohort study | Neurosciences Journal
    https://nsj.org.sa/content/30/2/131
    Objectives: To evaluate adherence to the guidelines in managing thunderclap headache (TCH) at King Abdullah Medical City Specialist Hospital (KAMC) in Makkah. A thunderclap headache, a severe and sudden onset headache, often signals a subarachnoid hemorrhage (SAH). The International Classification of Headache Disorders, 3rd edition (ICHD-3), recommends a diagnostic approach for TCH, including computed tomography (CT), lumbar puncture (LP), vascular studies, and magnetic resonance imagining (MRI). […] This retrospective cohort study aims to assess the compliance and application of the ICHD-3 recommendations and evaluate demographic characteristics, clinical features, and outcomes of patients presenting to the ED with TCH at King Abdullah Medical City Specialist Hospital (KAMC) and the approach to their management. The results from this study can contribute to a deep understanding of the compliance rate with ICHD-3 guidelines and the outcomes of current clinical practices in diagnosing and managing this potentially life-threatening condition.
  • #17 Acute Headache in Adults: A Diagnostic Approach | AAFP
    https://www.aafp.org/pubs/afp/issues/2022/0900/acute-headache-adults.html
    A detailed history and physical examination can distinguish between key features of benign primary headaches and concerning symptoms that warrant further evaluation for a secondary headache. […] Red flag signs or symptoms such as acute thunderclap headache, fever, meningeal irritation on physical examination, papilledema with focal neurologic signs, impaired consciousness, and concern for acute glaucoma warrant immediate evaluation. […] Patients with acute thunderclap headache should be sent to the emergency department and should receive computed tomography of the head within 12 hours of symptom onset. […] Immediate evaluation is necessary for acute thunderclap headache because of its high pretest probability (greater than 40%) for serious intracranial pathology such as subarachnoid hemorrhage. […] A lumbar puncture must follow a normal computed tomography scan to exclude subarachnoid hemorrhage. […] Patients presenting with acute thunderclap headache should have a CT scan performed within 12 hours of onset.
  • #18 Thunderclap headache management among Emergency Department visitors in tertiary care center in Makkah City: Retrospective cohort study | Neurosciences Journal
    https://nsj.org.sa/content/30/2/131
    The study revealed that the majority of patients (91.3%) were diagnosed with hemorrhagic conditions, with SAH being the most prevalent (85.5%), which aligns with existing literature indicating SAH as the leading cause of TCH. Prompt diagnostic measures were apparent, with 99.3% of SAH patients undergoing CT scans within 6 hours of ED arrival. […] The study highlights the importance of timely intervention and suggests that demographic factors may not significantly influence TCH outcomes. Further research should explore guideline adherence in varied settings.
  • #19 Headache Disorders: Differentiating Primary and Secondary Etiologies
    https://www.imrpress.com/journal/JIN/23/2/10.31083/j.jin2302043/htm
    Subarachnoid hemorrhage (SAH) is a life-threatening medical emergency that classically presents within the emergency department and characterized by a thunderclap headache, defined as a severe headache with an acute onset that reaches maximum intensity in less than one minute. […] The presence of acute-onset headaches should prompt at least a consideration of SAH. […] While a thunderclap headache should always prompt a workup, since a wide range of other etiologies can present with a thunderclap headache, additional clues in the clinical history can help narrow the differential diagnosis. […] The most studied decision-making tool is the Ottawa SAH rule which has been prospectively validated. […] The Ottawa SAH Rule had a 100% sensitivity, 13.6–15.3% specificity, and similar neuroimaging rates in subsequent validation studies. […] RCVS is estimated to be the cause of 8–45% of thunderclap headaches in which SAH has been excluded.
  • #20 Thunderclap headache syndrome presenting to the emergency department: an international multicentre observational cohort study – PubMed
    https://pubmed.ncbi.nlm.nih.gov/35144978/
    Thunderclap headache presenting to the ED appears be associated with higher risk for serious intracranial pathology, including SAH, although most patients with this type of headache had a benign cause. […] The objective of this study was to determine if patients presenting with thunderclap headache are significantly more likely to have serious underlying pathology than patients with more gradual onset and to determine compliance with guidelines for investigation. […] The incidence of subarachnoid haemorrhage (SAH) was 3.6% (95% CI 2.4% to 5.3%) in those with thunderclap headache vs 0.3% (95% CI 0.2% to 0.5%) in those without (p0.001). […] Neuroimaging rates did not align with international guidelines, suggesting potential need for further work on standardisation.
  • #21 Thunderclap headache – Wikipedia
    https://en.wikipedia.org/wiki/Thunderclap_headache
    Incidence of thunderclap headache has been estimated at 43 per 100,000 people every year. Approximately 75% are attributed to „primary” headaches: headache disorder, non-specific headache, idiopathic thunderclap headache or uncertain headache disorder. The remainder is attributed to secondary causes: vascular problems, infections and various other conditions. […] The most important of the secondary causes are subarachnoid hemorrhage, cerebral venous sinus thrombosis, and dissection of an artery in the neck.
  • #22 Thunderclap headache – Wikipedia
    https://en.wikipedia.org/wiki/Thunderclap_headache
    Incidence of thunderclap headache has been estimated at 43 per 100,000 people every year. Approximately 75% are attributed to „primary” headaches: headache disorder, non-specific headache, idiopathic thunderclap headache or uncertain headache disorder. The remainder is attributed to secondary causes: vascular problems, infections and various other conditions. […] The most important of the secondary causes are subarachnoid hemorrhage, cerebral venous sinus thrombosis, and dissection of an artery in the neck.
  • #23 Thunderclap Headache – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK560629/
    A systematic literature review reported poor population-based data to accurately identify the true incidence and prevalence of thunderclap headaches. The authors determined that the only estimate of a population-based incidence is from the study of a subset of a Swedish population. The incidence is reportedly 43 per 100,000 inhabitants older than 18 years annually. […] A population-based study in Italy showed a 0.3% lifetime prevalence of TCH in men and women aged 55 to 94. […] TCH in the pediatric population is considered very rare, but data are limited. In a recent retrospective study of children and adolescents aged 6 to 18 years presenting to a pediatric emergency department, TCH was diagnosed in 19 out of 2290 (0.8%) of the included patients. […] In patients presenting with a TCH, subarachnoid hemorrhage is found in 11 to 25% and other intracranial hemorrhages in 5 and 10%. […] TCH is the presenting symptom in 20% of patients with cervical artery dissection, 2 to 16% with cerebral venous thrombosis, 15% with intracranial hypotension, and 2% with bacterial or viral meningitis.
  • #24 Thunderclap Headache – Pearls and Pitfalls – emDocs
    https://www.emdocs.net/thunderclap-headache-pearls-pitfalls/
    A thunderclap headache (TCH) has been defined as a “headache that reaches 7 (out of 10) or more in intensity within less than one minute.” TCH is often unexpected and not preceded by any warning signs or symptoms. […] The classic teaching in medical school is that a “thunderclap” headache is pathognomonic for subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm. However, only 11-25% of TCHs are due to SAH. […] As TCH is a common presentation of a SAH, any patient that presents with TCH must be evaluated for SAH due to high morbidity and mortality. According to literature, the average fatality rate of SAH is 51%. […] A headache occurs in 75-95% of patients with cerebral venous thrombosis (CVT). While the onset of headache in CVT is usually gradual, about 2-13% of patients experience a TCH as the primary symptom.
  • #25 Headache Disorders: Differentiating Primary and Secondary Etiologies
    https://www.imrpress.com/journal/JIN/23/2/10.31083/j.jin2302043/htm
    Subarachnoid hemorrhage (SAH) is a life-threatening medical emergency that classically presents within the emergency department and characterized by a thunderclap headache, defined as a severe headache with an acute onset that reaches maximum intensity in less than one minute. […] The presence of acute-onset headaches should prompt at least a consideration of SAH. […] While a thunderclap headache should always prompt a workup, since a wide range of other etiologies can present with a thunderclap headache, additional clues in the clinical history can help narrow the differential diagnosis. […] The most studied decision-making tool is the Ottawa SAH rule which has been prospectively validated. […] The Ottawa SAH Rule had a 100% sensitivity, 13.6–15.3% specificity, and similar neuroimaging rates in subsequent validation studies. […] RCVS is estimated to be the cause of 8–45% of thunderclap headaches in which SAH has been excluded.
  • #26 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 ISCVT (International Study on Cerebral Venous and Dural Sinuses Thrombosis) found that approximately 78% of cases occurred in people younger than 50. […] 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.
  • #27 A common cause of sudden and thunderclap headaches: reversible cerebral vasoconstriction syndrome | The Journal of Headache and Pain | Full Text
    https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/1129-2377-15-13
    Thunderclap headache (TCH) is a sudden headache (SH) with accepted criteria of severe intensity and onset to peak within one minute. […] Reversible cerebral vasoconstriction syndrome (RCVS) is a common cause of SH and TCH. […] Considering the potential mortality and morbidity of RCVS, systemic examination of cerebral vessels should be performed in these patients. […] Recently, reversible cerebral vasoconstriction syndrome (RCVS) has been added to the list of TCH differential diagnoses. […] It has been postulated that RCVS accounts for most of these benign TCH cases. […] Our results show that about one-half of these patients exhibit RCVS. […] In conclusion, our study provides direct evidence that RCVS is a common and likely under-recognized cause of SH and TCH.
  • #28 Thunderclap Headache – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK560629/
    A systematic literature review reported poor population-based data to accurately identify the true incidence and prevalence of thunderclap headaches. The authors determined that the only estimate of a population-based incidence is from the study of a subset of a Swedish population. The incidence is reportedly 43 per 100,000 inhabitants older than 18 years annually. […] A population-based study in Italy showed a 0.3% lifetime prevalence of TCH in men and women aged 55 to 94. […] TCH in the pediatric population is considered very rare, but data are limited. In a recent retrospective study of children and adolescents aged 6 to 18 years presenting to a pediatric emergency department, TCH was diagnosed in 19 out of 2290 (0.8%) of the included patients. […] In patients presenting with a TCH, subarachnoid hemorrhage is found in 11 to 25% and other intracranial hemorrhages in 5 and 10%. […] TCH is the presenting symptom in 20% of patients with cervical artery dissection, 2 to 16% with cerebral venous thrombosis, 15% with intracranial hypotension, and 2% with bacterial or viral meningitis.
  • #29 Thunderclap Headache: When Secondary Disorders Are the Cause
    https://www.medscape.com/viewarticle/913483
    The term „thunderclap headache” (TCH) refers to a headache that has an abrupt onset, reaching maximum intensity in 1 minute or less and lasting for at least 5 minutes. […] Approximately 10%-25% of patients with TCH have subarachnoid hemorrhage (SAH). […] The most common cause of spontaneous SAH is rupture of a saccular intracranial aneurysm. Moreover, the most common symptom of a ruptured aneurysm is TCH. […] Patients with reversible cerebral vasoconstriction syndrome (RCVS) also may present with a TCH. […] TCH is present in 20% of patients with dissection in one of the cervical arteries. […] TCH is present in 2%-10% of patients with cerebral sinus venous thrombosis (CST).
  • #30 Thunderclap Headache – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK560629/
    A systematic literature review reported poor population-based data to accurately identify the true incidence and prevalence of thunderclap headaches. The authors determined that the only estimate of a population-based incidence is from the study of a subset of a Swedish population. The incidence is reportedly 43 per 100,000 inhabitants older than 18 years annually. […] A population-based study in Italy showed a 0.3% lifetime prevalence of TCH in men and women aged 55 to 94. […] TCH in the pediatric population is considered very rare, but data are limited. In a recent retrospective study of children and adolescents aged 6 to 18 years presenting to a pediatric emergency department, TCH was diagnosed in 19 out of 2290 (0.8%) of the included patients. […] In patients presenting with a TCH, subarachnoid hemorrhage is found in 11 to 25% and other intracranial hemorrhages in 5 and 10%. […] TCH is the presenting symptom in 20% of patients with cervical artery dissection, 2 to 16% with cerebral venous thrombosis, 15% with intracranial hypotension, and 2% with bacterial or viral meningitis.
  • #31 Thunderclap Headache: When Secondary Disorders Are the Cause
    https://www.medscape.com/viewarticle/913483
    The term „thunderclap headache” (TCH) refers to a headache that has an abrupt onset, reaching maximum intensity in 1 minute or less and lasting for at least 5 minutes. […] Approximately 10%-25% of patients with TCH have subarachnoid hemorrhage (SAH). […] The most common cause of spontaneous SAH is rupture of a saccular intracranial aneurysm. Moreover, the most common symptom of a ruptured aneurysm is TCH. […] Patients with reversible cerebral vasoconstriction syndrome (RCVS) also may present with a TCH. […] TCH is present in 20% of patients with dissection in one of the cervical arteries. […] TCH is present in 2%-10% of patients with cerebral sinus venous thrombosis (CST).
  • #32 Thunderclap Headache – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK560629/
    A systematic literature review reported poor population-based data to accurately identify the true incidence and prevalence of thunderclap headaches. The authors determined that the only estimate of a population-based incidence is from the study of a subset of a Swedish population. The incidence is reportedly 43 per 100,000 inhabitants older than 18 years annually. […] A population-based study in Italy showed a 0.3% lifetime prevalence of TCH in men and women aged 55 to 94. […] TCH in the pediatric population is considered very rare, but data are limited. In a recent retrospective study of children and adolescents aged 6 to 18 years presenting to a pediatric emergency department, TCH was diagnosed in 19 out of 2290 (0.8%) of the included patients. […] In patients presenting with a TCH, subarachnoid hemorrhage is found in 11 to 25% and other intracranial hemorrhages in 5 and 10%. […] TCH is the presenting symptom in 20% of patients with cervical artery dissection, 2 to 16% with cerebral venous thrombosis, 15% with intracranial hypotension, and 2% with bacterial or viral meningitis.
  • #33 Thunderclap Headache – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK560629/
    A systematic literature review reported poor population-based data to accurately identify the true incidence and prevalence of thunderclap headaches. The authors determined that the only estimate of a population-based incidence is from the study of a subset of a Swedish population. The incidence is reportedly 43 per 100,000 inhabitants older than 18 years annually. […] A population-based study in Italy showed a 0.3% lifetime prevalence of TCH in men and women aged 55 to 94. […] TCH in the pediatric population is considered very rare, but data are limited. In a recent retrospective study of children and adolescents aged 6 to 18 years presenting to a pediatric emergency department, TCH was diagnosed in 19 out of 2290 (0.8%) of the included patients. […] In patients presenting with a TCH, subarachnoid hemorrhage is found in 11 to 25% and other intracranial hemorrhages in 5 and 10%. […] TCH is the presenting symptom in 20% of patients with cervical artery dissection, 2 to 16% with cerebral venous thrombosis, 15% with intracranial hypotension, and 2% with bacterial or viral meningitis.
  • #34 Thunderclap Headache – Pearls and Pitfalls – emDocs
    https://www.emdocs.net/thunderclap-headache-pearls-pitfalls/
    A cervical artery dissection can result in an ischemic stroke, transient ischemic attack, or more rarely a SAH. […] About 25-34% of patients with stroke develop an associated headache. […] The most common cause of spontaneous intracranial hypotension is CSF leakage from spinal meningeal defects or dural tears. […] Meningitis can very rarely present with TCH. A prospective study of patients presenting with TCH found 2.7% to have an infectious etiology. […] Pituitary apoplexy occurs with hemorrhage or infarction of the pituitary gland. […] Temporal arteritis is a very rare cause of TCH. […] Reversible Cerebral Vasoconstriction Syndrome (RCVS) includes conditions associated with TCH and diffuse, segmental, reversible vasospasm. RCVS is thought to account for most cases of TCH that are termed “benign,” or unexplained. […] Every patient with TCH must be assumed to have a life-threatening intracranial condition.
  • #35 Thunderclap Headache – Pearls and Pitfalls – emDocs
    https://www.emdocs.net/thunderclap-headache-pearls-pitfalls/
    A cervical artery dissection can result in an ischemic stroke, transient ischemic attack, or more rarely a SAH. […] About 25-34% of patients with stroke develop an associated headache. […] The most common cause of spontaneous intracranial hypotension is CSF leakage from spinal meningeal defects or dural tears. […] Meningitis can very rarely present with TCH. A prospective study of patients presenting with TCH found 2.7% to have an infectious etiology. […] Pituitary apoplexy occurs with hemorrhage or infarction of the pituitary gland. […] Temporal arteritis is a very rare cause of TCH. […] Reversible Cerebral Vasoconstriction Syndrome (RCVS) includes conditions associated with TCH and diffuse, segmental, reversible vasospasm. RCVS is thought to account for most cases of TCH that are termed “benign,” or unexplained. […] Every patient with TCH must be assumed to have a life-threatening intracranial condition.
  • #36 Overview of thunderclap headache – UpToDate
    https://www.uptodate.com/contents/overview-of-thunderclap-headache
    INTRODUCTION […] 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 (table 1). 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.
  • #37 Evaluation of the adult with nontraumatic headache in the emergency department – UpToDate
    https://www.uptodate.com/contents/evaluation-of-the-adult-with-nontraumatic-headache-in-the-emergency-department
    Sudden-onset „thunderclap” headache […] Severe headache of sudden onset (ie, typically reaching maximal intensity within a few seconds or less than one minute after the onset of pain) is known as „thunderclap headache” because its explosive and unexpected nature is likened to a clap of thunder. Approximately 8 percent of emergency department (ED) patients with a thunderclap headache have a subarachnoid hemorrhage. Although less well-known, reversible cerebral vasoconstriction syndromes (RCVS) are the second most common cause of thunderclap headache. […] Failure to evaluate patients with thunderclap headache thoroughly and expeditiously can result in misdiagnosis with resultant poor outcomes due to rebleeding, early hydrocephalus, or vasospasm. Misdiagnosed patients generally appear less ill and do not have neurologic deficits; misdiagnosis stems from a lack of appreciation of the range of possible presentations of patients with SAH and failure to do a CT or LP.
  • #38 Thunderclap Headache – Pearls and Pitfalls – emDocs
    https://www.emdocs.net/thunderclap-headache-pearls-pitfalls/
    A thunderclap headache (TCH) has been defined as a “headache that reaches 7 (out of 10) or more in intensity within less than one minute.” TCH is often unexpected and not preceded by any warning signs or symptoms. […] The classic teaching in medical school is that a “thunderclap” headache is pathognomonic for subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm. However, only 11-25% of TCHs are due to SAH. […] As TCH is a common presentation of a SAH, any patient that presents with TCH must be evaluated for SAH due to high morbidity and mortality. According to literature, the average fatality rate of SAH is 51%. […] A headache occurs in 75-95% of patients with cerebral venous thrombosis (CVT). While the onset of headache in CVT is usually gradual, about 2-13% of patients experience a TCH as the primary symptom.
  • #39 Thunderclap Headache: Every Second Counts in Brain Emergencies | Cedars-Sinai
    https://www.cedars-sinai.org/blog/thunderclap-headache-hemorrhagic-stroke.html
    Thunderclap headaches like Julie’s come on quicklyusually in under 60 secondsand are the worst headaches of your life, Dr. Carlin explains. They’re a major warning sign of hemorrhagic stroke, as well as other life-threatening conditions such as severely high blood pressure or even meningitis. […] She urges anyone experiencing thunderclap headaches to call 911 immediately. […] About 13% of strokes are hemorrhagic, according to the American Stroke Association. […] More than 30% of stroke patients develop subarachnoid hemorrhage. […] The exact cause of RCVS is unclear, but there are known risk factors, including head trauma, binge drinking, heavy, daily marijuana use, certain antidepressants, nasal decongestants and hormone supplementation. […] Because Julie’s brain bleed was stable and caught in time, the stroke didn’t permanently impair her physical functioning or require rehabilitation for speech or movement. […] „If Julie had not come in, it definitely could have progressed and resulted in further brain injury,” Dr. Carlin cautions.
  • #40 Thunderclap Headache: Every Second Counts in Brain Emergencies | Cedars-Sinai
    https://www.cedars-sinai.org/blog/thunderclap-headache-hemorrhagic-stroke.html
    Thunderclap headaches like Julie’s come on quicklyusually in under 60 secondsand are the worst headaches of your life, Dr. Carlin explains. They’re a major warning sign of hemorrhagic stroke, as well as other life-threatening conditions such as severely high blood pressure or even meningitis. […] She urges anyone experiencing thunderclap headaches to call 911 immediately. […] About 13% of strokes are hemorrhagic, according to the American Stroke Association. […] More than 30% of stroke patients develop subarachnoid hemorrhage. […] The exact cause of RCVS is unclear, but there are known risk factors, including head trauma, binge drinking, heavy, daily marijuana use, certain antidepressants, nasal decongestants and hormone supplementation. […] Because Julie’s brain bleed was stable and caught in time, the stroke didn’t permanently impair her physical functioning or require rehabilitation for speech or movement. […] „If Julie had not come in, it definitely could have progressed and resulted in further brain injury,” Dr. Carlin cautions.
  • #41 Thunderclap Headache: An Overview – Neurology Advisor
    https://www.neurologyadvisor.com/features/thunderclap-headache-an-overview/
    Although thunderclap headache (TCH) is rare, it can indicate the presence of a serious underlying disorder and thus warrants immediate medical attention. […] TCH may be the only early warning sign of vascular changes or brain injury. […] 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.
  • #42 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. […] There is only one population-based estimate of the incidence of sudden and severe headache at 43 cases per 100,000. […] 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. […] 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. […] Our review collates a large number of published causes of sudden and severe headache and may serve as a benchmark for clinicians and researchers alike, as we estimate that our review may be 98% complete.
  • #43 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. […] There is only one population-based estimate of the incidence of sudden and severe headache at 43 cases per 100,000. […] 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. […] 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. […] Our review collates a large number of published causes of sudden and severe headache and may serve as a benchmark for clinicians and researchers alike, as we estimate that our review may be 98% complete.
  • #44 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. […] There is only one population-based estimate of the incidence of sudden and severe headache at 43 cases per 100,000. […] 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. […] 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. […] Our review collates a large number of published causes of sudden and severe headache and may serve as a benchmark for clinicians and researchers alike, as we estimate that our review may be 98% complete.
  • #45 Thunderclap headache management among Emergency Department visitors in tertiary care center in Makkah City: Retrospective cohort study | Neurosciences Journal
    https://nsj.org.sa/content/30/2/131
    Objectives: To evaluate adherence to the guidelines in managing thunderclap headache (TCH) at King Abdullah Medical City Specialist Hospital (KAMC) in Makkah. A thunderclap headache, a severe and sudden onset headache, often signals a subarachnoid hemorrhage (SAH). The International Classification of Headache Disorders, 3rd edition (ICHD-3), recommends a diagnostic approach for TCH, including computed tomography (CT), lumbar puncture (LP), vascular studies, and magnetic resonance imagining (MRI). […] This retrospective cohort study aims to assess the compliance and application of the ICHD-3 recommendations and evaluate demographic characteristics, clinical features, and outcomes of patients presenting to the ED with TCH at King Abdullah Medical City Specialist Hospital (KAMC) and the approach to their management. The results from this study can contribute to a deep understanding of the compliance rate with ICHD-3 guidelines and the outcomes of current clinical practices in diagnosing and managing this potentially life-threatening condition.
  • #46 Thunderclap headache management among Emergency Department visitors in tertiary care center in Makkah City: Retrospective cohort study | Neurosciences Journal
    https://nsj.org.sa/content/30/2/131
    The study revealed that the majority of patients (91.3%) were diagnosed with hemorrhagic conditions, with SAH being the most prevalent (85.5%), which aligns with existing literature indicating SAH as the leading cause of TCH. Prompt diagnostic measures were apparent, with 99.3% of SAH patients undergoing CT scans within 6 hours of ED arrival. […] The study highlights the importance of timely intervention and suggests that demographic factors may not significantly influence TCH outcomes. Further research should explore guideline adherence in varied settings.
  • #47 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 ISCVT (International Study on Cerebral Venous and Dural Sinuses Thrombosis) found that approximately 78% of cases occurred in people younger than 50. […] 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.
  • #48 Thunderclap headache syndrome presenting to the emergency department: an international multicentre observational cohort study – PubMed
    https://pubmed.ncbi.nlm.nih.gov/35144978/
    Thunderclap headache presenting to the ED appears be associated with higher risk for serious intracranial pathology, including SAH, although most patients with this type of headache had a benign cause. […] The objective of this study was to determine if patients presenting with thunderclap headache are significantly more likely to have serious underlying pathology than patients with more gradual onset and to determine compliance with guidelines for investigation. […] The incidence of subarachnoid haemorrhage (SAH) was 3.6% (95% CI 2.4% to 5.3%) in those with thunderclap headache vs 0.3% (95% CI 0.2% to 0.5%) in those without (p0.001). […] Neuroimaging rates did not align with international guidelines, suggesting potential need for further work on standardisation.
  • #49 Thunderclap Headaches – Types, Causes, Symptoms, Diagnosis, Treatment and Prevention
    https://www.medindia.net/health/conditions/thunderclap-headaches.htm
    Thunderclap headaches, as the name suggests, strike like a bolt from the blue, just like a clap of thunder, without any warning. This rare headache disorder is severe and explosive in nature, often appearing without any apparent trigger. The intense pain peaks within 60 seconds and lasts for at least 5 minutes. These headaches warn of potentially serious underlying conditions such as brain hemorrhage and other complications. Thunderclap headaches require prompt medical attention. […] The annual global incidence of thunderclap headaches is estimated to be 43 per 100,000 adults in the developed countries. There is a corresponding sparsity of data in the developing countries. A recent study from Paris, France suggests that 1.5% of all headache patients could be due to thunderclap headaches.
  • #50 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.
  • #51 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.

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