Materiały źródłowe

• #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. […] 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. […] What differentiates thunderclap headaches from other headache types is how rapidly they reach their peak intensity, not the headache intensity itself. […] TCH is often associated with a potentially fatal etiology, such as subarachnoid hemorrhage (SAH), and is considered a medical emergency. […] Evidence suggests the sympathetic nervous system plays a central role in the abnormal cerebrovascular tone causing vasoconstriction and vasospasm, leading to head pain. […] Once the etiology of secondary TCH in a patient is known, the pathophysiology of the specific condition applies. However, generally speaking, the pathophysiology of primary and secondary TCH is unclear. […] There are only a few case reports on primary TCH treatment, and evidence supporting that TCH exists as a primary disorder is poor. Therefore, the treatment and management are focused almost exclusively on secondary TCH.

• #2 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. […] DEFINITION […] 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. […] However, „sudden” may be to some extent subjective; patients or physicians are not always so precise. In a series of 2131 patients with acute-onset headache peaking within one hour, including 132 with subarachnoid hemorrhage, the interobserver agreement about sudden onset was only fair, and 6 of 132 patients with subarachnoid hemorrhage had a time to peak headache intensity of up to one hour. Therefore, care must be taken in defining sudden onset. Other severe headaches may be worrisome and compel a diagnostic evaluation but would not qualify as TCH unless reaching maximum intensity quickly.

• #3 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 can be divided broadly into two groups: Those caused by vascular or blood vessel problems, injury, or uncommon structural problems in the brain; Those that have no clear cause and, following medical evaluation, are felt to be benign (not dangerous).

• #3 Thunderclap Headaches | American Migraine Foundation

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

  Abrupt, severe headaches triggered by activity—including sexual activity or straining to have a bowel movement—or headaches coming on after an injury have especially high potential to be dangerous. […] A decrease in blood flow to the brain can cause a severe headache, and is often accompanied by weakness, numbness, or changes in vision or sensation. Sudden decreases in blood flow can come from blood vessels narrowing (spasming), rupturing, a stroke, a head injury, or a structural weakening of blood vessel walls, as can occur with an aneurysm. […] Dissection (a tear in the wall of a blood vessel) and aneurysm (a weakening in the wall of a blood vessel) can both cause sudden, painful headaches. […] The rupture of a blood vessel in the brain can result in a hemorrhagic stroke. […] A sudden blood vessel blockage caused by a blood clot or thrombosis, or from a cholesterol build-up, can result in a different kind of stroke.

• #4 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 of the secondary causes are subarachnoid hemorrhage, cerebral venous sinus thrombosis, and dissection of an artery in the neck. […] In subarachnoid hemorrhage, there may be syncope (transient loss of consciousness), seizures, meningism (neck pain and stiffness), visual symptoms, and vomiting. 50-70% of people with subarachnoid hemorrhage have an isolated headache without decreased level of consciousness. The headache typically persists for several days.

• #5 Primary thunderclap headache – PubMed

  https://pubmed.ncbi.nlm.nih.gov/20816448/

  Thunderclap headache is an uncommon type of headache, but recognition and diagnosis are important because of the possibility of a serious underlying brain disorder. […] The pathogenesis of primary thunderclap headache is still not known, but the sympathetic nervous system may play an important role.

• #6 4.4 Primary thunderclap headache – ICHD-3

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

  High-intensity headache of abrupt onset, mimicking that of ruptured cerebral aneurysm, in the absence of any intracranial pathology. […] 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. Other organic causes of thunderclap headache are meningitis, colloid cyst of the third ventricle, spontaneous intracranial hypotension and acute sinusitis (particularly with barotrauma). […] Evidence that thunderclap headache exists as a primary disorder is poor: the search for an underlying cause should be both expedited and exhaustive.

• #7 Thunderclap Headache | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30123

  Day and Raskin are credited with coining the term thunderclap headache (TCH). […] They concluded, „Hemorrhage into the wall of an aneurysm is a possible cause of thunderclap headache attacks before rupture.” […] TCH is defined as a high-intensity headache of abrupt onset, mimicking that of a ruptured cerebral aneurysm, in the absence of any intracranial pathology. […] However, 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.” […] What differentiates thunderclap headaches from other headache types is how rapidly they reach their peak intensity, not the headache intensity itself. […] TCH is often associated with a potentially fatal etiology, such as subarachnoid hemorrhage (SAH), and is considered a medical emergency.

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

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

  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. […] Thunderclap headaches are often caused by a rapid change in blood flow to the brain, which could be due to: problems with the blood vessels, head injury, bleeding in the brain, hemorrhagic or ischemic stroke, reversible cerebral vasoconstriction syndrome. […] Many causes of thunderclap headaches are life threatening if not diagnosed and treated promptly. Conditions that may be associated with thunderclap headaches include: strokes, migraine, head injury, high blood pressure.

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

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

  This rare type of severe headache comes on suddenly. The cause, which can be life-threatening, is often some kind of bleeding in or around your brain. […] Thunderclap headaches could be caused by bleeding from an artery into the space surrounding your brain. This is known as a subarachnoid hemorrhage. […] Those with a predisposition to anything that suddenly increases the pressure in their brain are susceptible to these headaches because it makes it more likely that a damaged artery will bleed. […] A thunderclap headache could also be caused by any of the following: Small tears in the arteries of your head or neck, Blocked veins in your head, Leaking spinal fluid, Rapid changes in blood pressure, An infection in your brain, Head injury, Hemorrhagic stroke (This comes from a ruptured blood vessel in your brain.), Inflamed blood vessels, Extremely high blood pressure in late pregnancy, Drugs like cocaine or amphetamines, Brain aneurysms (silent until the bleed). […] Thunderclap headache treatment depends on what’s causing the pain.

• #10 Thunderclap Headaches | American Migraine Foundation

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

  A decrease in blood flow to the brain can cause a severe headache, and is often accompanied by weakness, numbness, or changes in vision or sensation. Sudden decreases in blood flow can come from blood vessels narrowing (spasming), rupturing, a stroke, a head injury, or a structural weakening of blood vessel walls, as can occur with an aneurysm. […] Dissection (a tear in the wall of a blood vessel) and aneurysm (a weakening in the wall of a blood vessel) can both cause sudden, painful headaches. […] The rupture of a blood vessel in the brain can result in a hemorrhagic stroke. […] A sudden blood vessel blockage caused by a blood clot or thrombosis, or from a cholesterol build-up, can result in a different kind of stroke. […] Depending on the age of the individual, a severe headache can occur hours to days after a mild-to-moderate head injury.

• #10 Thunderclap Headaches | American Migraine Foundation

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

  In this often difficult-to-diagnose disorder, there is a temporary narrowing or spasming of a blood vessel surrounding the brain. […] Vasculitis, or blood vessel inflammation, comes from an autoimmune attack—that is, the body attacking its own blood vessels. […] In pregnancy, sudden new headaches may signal a number of different disorders, particularly late in pregnancy. […] Sudden, extreme head pain—even without other symptoms—can serve as a warning of a larger bleed or stroke to come. […] If doctors find no specific cause after a medical examination, they may then start treatment for what is called primary thunderclap headache, which is considered benign. […] If these headaches occur predictably at certain times, such as with sexual activity, then treating them with medication such as a non-steroidal anti-inflammatory (NSAID)—in particular, indomethacin—may be all that is needed. […] 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.

• #11 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), a recently recognized syndrome characterized by recurrent TCH attacks, has been proposed to account for most of these patients. […] Reversible cerebral vasoconstriction syndrome is a common cause of SH and TCH. […] RCVS is a unifying term which encompasses a group of recurrent headache syndromes including: Call-Fleming syndrome, thunderclap headache with reversible vasospasm, benign angiopathy of the central nervous system, postpartum cerebral angiopathy, among others. […] The clinical presentation of RCVS is characterized by recurrent TCH attacks and multifocal vasoconstriction which resolves within 2 to 3 months. […] It has been postulated that RCVS is under-recognized and accounts for most benign TCH. […] 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.

• #12 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). […] 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. […] The most important hypothesis is an alteration in the autonomic regulation of cerebral vascular tone, which leads to multifocal narrowing of the cerebral arteries and severe headache.

• #13 Reversible Cerebral Vasoconstriction Syndrome Presenting with Thunderclap Headache in a Child

  https://www.annchildneurol.org/journal/view.php?number=1301

  Another proposed mechanism is increased leakage of the blood-brain barrier caused by the disruption of arterial tone; this has been postulated as a hypothesis for PRES, which is present in 25% of pediatric RCVS patients. […] Stress or emotional changes that increase endogenous catecholamine release are also thought to be related to the development of RCVS. […] More than 90% of patients with RCVS have a favorable prognosis, with a monophasic pattern. […] However, major neurological complications, including stroke, intracranial hemorrhage, and PRES, can occur, particularly in patients with specific comorbidities, such as hemolytic uremic syndrome, systemic lupus erythematosus, and sickle cell disease. […] Brain MRI and MRA should be performed for children with severe and recurrent thunderclap headaches, the most common symptom in RCVS. […] Serial neuroimaging may be needed because initial imaging can show normal findings in patients with RCVS within 1 to 2 weeks of headache onset.

• #14 Cervical spine instability induced Thunderclap headache –

  https://caringmedical.com/prolotherapy-news/thunderclap-headache-vagus-nerve/

  The function of cerebral blood vessels is maintained by signals mainly supplied by sympathetic nerves arising from the superior cervical sympathetic ganglion. […] If upper cervical instability interrupts the superior cervical sympathetic ganglion’s electrical output, the results on human health could therefore be devastating. […] Some authors call the sympathetic superior cervical ganglia “little neuroendocrine brains,” as they provide sympathetic innervation to the hypothalamus, pineal gland, cephalic blood vessels, choroid plexus, eye, myocardium, carotid body, and the salivary and thyroid glands. […] Removal of the superior cervical ganglia can cause loss of vasoconstriction control of brain and pituitary blood vessels, changes in cerebrospinal fluid production from the choroid plexus, and other central effects in response to partial sympathetic denervation.

• #15 Annals of Child Neurology

  https://www.annchildneurol.org/m/journal/view.php?number=1301

  Another proposed mechanism is increased leakage of the blood-brain barrier caused by the disruption of arterial tone; this has been postulated as a hypothesis for PRES, which is present in 25% of pediatric RCVS patients. […] Stress or emotional changes that increase endogenous catecholamine release are also thought to be related to the development of RCVS.

• #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

  Thunderclap headache is often associated with serious vascular intracranial disorders, particularly subarachnoid haemorrhage (SAH). The search for an underlying cause should be immediate and exhaustive. […] 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. Aneursymal SAH is therefore the diagnosis of foremost consideration in this scenario. […] A greater understanding of reversible cerebral vasoconstriction syndrome (RCVS) has emerged in the past few years because of the wider availability of relatively noninvasive technologies to assess the cerebral vasculature. […] The diagnostic criteria for RCVS include thunderclap headache(s) with or without focal neurological deficits or seizures, often recurrent episodes of thunderclap headache during the first month but usually no new symptoms appearing after this time, multifocal, multivessel, segmental vasoconstriction of cerebral arteries, absence of aneurysmal SAH, normal or near normal cerebrospinal fluid analysis, and complete or substantial normalisation of cerebral arteries within 12 weeks of symptom onset.

• #17 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. […] 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. […] The most common cause not mentioned in academic reviews was pneumocephalus. […] We identified 234 cases where vasoconstriction was a plausible or proven mechanism for headache. […] Our review still supports the concept that Vasoconstriction Syndromes are probably part of a spectrum of disorders with an isolated sudden and severe headache at one end and multiple headaches and serious neurovascular complications at the other. […] Our review identified 234 cases where vasoconstriction was a plausible or proven mechanism for headache. […] There is evidence that many cases of otherwise unexplained Sudden AND Severe Headache, particularly coital headache, are actually due to Reversible Cerebral Vasoconstriction.

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

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

  Thunderclap headaches live up to their name, striking suddenly like a clap of thunder. The pain of these severe headaches peaks within 60 seconds. […] 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. […] There’s no obvious cause for some thunderclap headaches. In other cases, a variety of potentially life-threatening conditions might be responsible, including: […] Bleeding between the brain and membranes covering the brain (subarachnoid hemorrhage) […] A rupture of a blood vessel in the brain […] A tear in the lining of an artery that supplies blood to the brain […] Leaking of cerebrospinal fluid usually due to a tear of the covering around a nerve root in the spine […] Death of tissue or bleeding in the pituitary gland […] A blood clot in the brain […] Severe elevation in blood pressure (hypertensive crisis) […] Infection such as meningitis or encephalitis […] Ischemic stroke.

• #19 Diagnosing secondary sudden onset (thunderclap) headaches | Medmastery

  https://www.medmastery.com/guides/headaches-clinical-guide/differentiating-severe-and-benign-secondary-sudden-onset-thunderclap?srsltid=AfmBOooMMCvWsFJxu89goZdQ4-1cMas8MhCGAs9FVcS01Q3byPoAAjUO

  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 hemorrhage (SAH), cervical artery dissection, stroke, and a hypertensive crisis. […] Severe and sudden onset headache may indicate subarachnoid hemorrhage due to aneurysmal rupture or a sentinel bleed from a leaking aneurysm. […] The most common cause of subarachnoid hemorrhage is rupture of a berry aneurysm producing a severe headache which can be associated with loss of consciousness.

• #20 Thunderclap headache – Wikipedia

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

  Cerebral venous sinus thrombosis, thrombosis of the veins of the brain, usually causes a headache that reflects raised intracranial pressure and is therefore made worse by anything that makes the pressure rise further, such as coughing. In 2-10% of cases, the headache is of thunderclap character. In most cases there are other neurological abnormalities, such as seizures and weakness of part of the body, but in 15-30% the headache is the only abnormality. […] Carotid artery dissection and vertebral artery dissection (together cervical artery dissection), in which a tear forms inside the wall of the blood vessels that supply the brain, often causes pain on the affected side of the head or neck. The pain usually precedes other problems that are caused by impaired blood flow through the artery into the brain; these may include visual symptoms, weakness of part of the body, and other abnormalities depending on the vessel affected.

• #21 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. […] The average fatality rate of SAH is 51%. […] A sentinel headache is a headache that occurs days or weeks prior to a ruptured cerebral aneurysm. […] A headache occurs in 75-95% of patients with cerebral venous thrombosis (CVT).

• #22 Thunderclap Headache – Pearls and Pitfalls – emDocs

  https://www.emdocs.net/thunderclap-headache-pearls-pitfalls/

  While CVT is a relatively rare disorder, 80% of patients with CVT are younger than 50. […] A cervical artery dissection can result in an ischemic stroke, transient ischemic attack, or more rarely a SAH. […] Headaches are reported in 60-95% of patients with carotid artery dissections and 70% of patients with vertebral artery dissections. […] Two case reports describe patients who presented with TCH from either a hypertensive crisis or posterior reversible encephalopathy syndrome (PRES). […] 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. […] Pituitary apoplexy occurs with hemorrhage or infarction of the pituitary gland.

• #23 Headache Disorders: Differentiating Primary and Secondary Etiologies

  https://www.imrpress.com/journal/JIN/23/2/10.31083/j.jin2302043/htm

  When clinical suspicion for SAH has been established, non-contrast computed tomography (CT) is the first diagnostic tool. […] A meta-analysis in 2016 showed that a non-contrast CT completed within six hours of headache onset had a 98.7% sensitivity, with many considering a negative head CT within this timeframe to be a “rule-out” for SAH. […] If non-contrast CT is not definitive, the next recommended tool is a lumbar puncture (LP). […] The preferred treatment modality is surgery which may vary in the form access including endoscopically or through a more traditional craniotomy. […] RCVS is estimated to be the cause of 8–45% of thunderclap headaches in which SAH has been excluded. […] The following clinical criteria are suggestive of RCVS: single or recurrent thunderclap headaches, multifocal segmental cerebral artery vasoconstriction typically within a week of onset, imaging findings may show FLAIR sulcal hyperintensities and/or vasogenic edema, and no evidence of aneurysmal subarachnoid hemorrhage.

• #24 Thunderclap Headache – PACES

  https://www.medicaleducationleeds.com/paces/thunderclap-headache/

  Causes of thunderclap headache: […] Subarachnoid Haemorrhage and sentinel headache […] Intracerebral Haemorrhage […] Cerebral Venous Thrombosis […] Cervical artery dissection […] Pituitary apoplexy […] Reversible cerebral vasoconstriction syndromes […] Acute hypertensive crisis with reversible posterior leukoencephalopathy syndrome […] Meningitis […] Spontaneous intracranial hypotension (CSF leakage from spinal meningeal defects or dural tears) […] The management depends on the underlying aetiology.

• #25 Thunderclap Headache – Pearls and Pitfalls – emDocs

  https://www.emdocs.net/thunderclap-headache-pearls-pitfalls/

  A retroclival hematoma is usually seen as a rare manifestation of severe head and neck injuries in which there is atlantoaxial dislocation. […] A colloid cyst of the third ventricle can impede the flow of CSF leading to obstructive hydrocephalus. […] Temporal arteritis is a very rare cause of TCH. […] Reversible Cerebral Vasoconstriction Syndrome (RCVS) includes conditions associated with TCH and diffuse, segmental, reversible vasospasm. […] Other conditions that have been reported in association with TCH include complicated sinusitis; cluster headache; primary cough, exertional, and sexual headaches; and primary TCH. […] Every patient with TCH must be assumed to have a life-threatening intracranial condition. […] The initial imaging modality is a noncontrast head CT. […] The majority of evidence states that conventional angiography is not necessary in patients with a normal head CT and LP. […] Even with a thorough workup, studies estimate that a diagnosis is made in only 27-71% of patients with TCH. […] The most common diagnosed cause of TCH is SAH.

• #26 Diagnosing secondary sudden onset (thunderclap) headaches | Medmastery

  https://www.medmastery.com/guides/headaches-clinical-guide/differentiating-severe-and-benign-secondary-sudden-onset-thunderclap?srsltid=AfmBOooMMCvWsFJxu89goZdQ4-1cMas8MhCGAs9FVcS01Q3byPoAAjUO

  Remember to also include in your list of differentials post-coital headache, a thunderclap-like primary headache disorder, which can occur before or with orgasm. […] Exertional headaches are a primary headache disorder, with a thunderclap-type presentation, precipitated by any type of exercise or high-level physical activity.

• #27 Thunderclap Headaches: Causes, Symptoms, and Treatments

  https://www.denveruppercervical.com/thunderclap-headache

  Psychotherapy is the primary treatment for multiple personality disorder, which can lead to thunderclap headaches. […] In non-life-threatening cases or after successful medical intervention, your doctor will likely prescribe medication to prevent future thunderclap headaches and the related complications. […] Blood pressure medicine is a common pharmaceutical prescribed after a thunderclap headache. […] Thunderclap headaches may be the symptom of a much more serious condition. […] These are the complications that may occur or worsen when a thunderclap headache goes undiagnosed or untreated: Recurrent thunderclap headaches, Severe pain, Issues in late-term pregnancy, Stroke, Death. […] The most common cause of thunderclap headaches is blood vessel problems. The best way to prevent thunderclap headaches may be to keep your cardiovascular system in great shape. […] Because several possible TCH causes involve the spine, chiropractic care may also prove to be a useful prevention technique, particularly if you are already at risk.

• #28 What is a Thunderclap Headache? | LifeMD

  https://lifemd.com/learn/what-are-thunderclap-headaches

  A thunderclap headache is a severe occipital headache head pain that targets the occipital nerves running through the scalp area. This type of headache causes sudden intense pain within the first 30 seconds. Most thunderclap headaches last for about 60 seconds. In rare cases, they last for weeks or longer. […] Research shows that most secondary thunderclap headaches are symptoms of an underlying health condition. However, primary thunderclap headaches are rare and do not always have a clear cause. Most health experts believe hemorrhages in the wall of an aneurysm is the direct cause of thunderclap headaches. […] Potential causes of secondary thunderclap headaches include: Blood vessel tear: A decrease in proper blood flow from weak blood vessel walls may lead to a thunderclap headache or aneurysm. Ruptured aneurysm: Bulges in blood vessels rupture during an aneurysm leading to intense head pain. Stroke: During a stroke, blood vessels become blocked or rupture. They commonly occur with uncontrolled high blood pressure. Blood clots: Blood clots block blood vessel passageways which increases cholesterol levels. This may cause severe head pain. Some medications like testosterone or estrogen may increase your risk for blood clots. Tumor: The growth of a tumor in the pituitary gland and other parts of the brain may cause thunderclap headaches. Spontaneous intracranial hypotension (SIH): A neurological condition resulting in fluid leaking from the spinal cord. The most common symptom is an intense headache. Meningitis: Inflammation that occurs around the brain and spinal cord. Head injury: A severe headache from trauma to the head forms within hours to days after an injury. Medications: Certain medications like testosterone, estrogen, birth control pills, marijuana, and stimulants may trigger thunderclap headaches. Harmful drugs like cocaine may also lead to thunderclap headaches. Reversible cerebral vasoconstriction syndrome (RCVS): This occurs when blood vessels in the brain narrow. Vasculitis: Inflammation in blood vessels after an autoimmune attack can trigger a thunderclap headache and a sudden loss of vision. Those over the age of 50 have an increased risk of vasculitis. […] Some women may experience headaches in the later stages of pregnancy. Changes in hormones happen in the pituitary gland. Pregnancy may trigger a type of thunderclap headache known as the pituitary apoplexy.

• #29 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. […] The culprit for Julie’s painful headaches and bleeding? Reversible cerebral vasoconstriction syndrome (RCVS). The underdiagnosed disorder squeezes blood vessels in the brain and forces arteries to narrow. More than 30% of stroke patients develop subarachnoid hemorrhage. […] RCVS can cut off blood supply and oxygen to the brain, making both hemorrhagic strokes (caused by bleeding) and ischemic strokes (caused by lack of oxygen) more likely. […] 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. […] With appropriate care, the vasospasm in RCVS can be reversed, usually within three months. […] 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.

• #30 %%title%% %%page%%

  https://www.apollohospitals.com/health-library/thunderclap-headache-causes-symptoms-and-treatment

  Thunderclap headaches can be a symptom of underlying problems in the brain. Its important to seek immediate medical attention in case thunderclap headaches are recurring because these can be fatal. Thunderclap headaches can be treated if given timely attention. […] The first and foremost step towards treating thunderclap headaches is to determine the cause through physical evaluation and CT scan. If nothing is detected through CT scan, then other imaging techniques are done to diagnose the cause, such as: […] As they occur without warning or they themselves are indications of serious neurological conditions, its difficult to prevent them. Once you know the cause of thunderclap headaches, it becomes easier to prevent or to manage them. Generally, high blood pressure and vascular problems can trigger thunderclap headaches, hence its important to maintain a healthy lifestyle to keep your blood pressure under control.

• #31 Overview of thunderclap headache – UpToDate

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

  CLINICAL PRESENTATION […] 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.

• #32 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. […] Thunderclap headaches strike without any warning. Sometimes theres no underlying medical cause to them, but other times theyre a sign of very serious underlying conditions that involve bleeding in and around your brain. […] Its important to seek medical attention immediately to rule out life-threatening causes of a thunderclap headache. […] In a secondary thunderclap headache, a health condition, such as blood vessel issues in your brain (for example, a brain aneurysm), causes it along with other symptoms. A secondary thunderclap headache is a sign of a potentially life-threatening condition.

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

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

  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 a thunderclap headache isnt associated with an urgent underlying condition (a primary thunderclap headache), your healthcare provider may treat it with medication. […] 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.

• #34 Acute Headache in Adults: A Diagnostic Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/acute-headache-adults.html

  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. […] Onset is sudden/abrupt (thunderclap headache*) Subarachnoid hemorrhage, other cranial or cervical vascular disorder, posterior fossa mass lesion Neuroimaging, lumbar puncture. […] A lumbar puncture must follow a normal computed tomography scan to exclude subarachnoid hemorrhage. […] Neuroimaging and an additional evaluation may be necessary to exclude life-threatening causes of headaches when red flags are present. […] For emergent evaluations of headache, non-contrast computed tomography (CT) of the head is sensitive enough to exclude a new intracranial hemorrhage or mass effect. […] Patients presenting with acute thunderclap headache should have a CT scan performed within 12 hours of onset.

• #35 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

  Angiography (magnetic resonance or CT) in RCVS will reveal multifocal vasoconstriction of multiple intracranial arteries that is maximal at about two to three weeks after symptom onset. The pattern is one of distal vasoconstriction initially, which may then move more proximally in the first several weeks after symptom onset, and then resolves (is reversible).

• #36 Diagnosing secondary sudden onset (thunderclap) headaches | Medmastery

  https://www.medmastery.com/guides/headaches-clinical-guide/differentiating-severe-and-benign-secondary-sudden-onset-thunderclap?srsltid=AfmBOooMMCvWsFJxu89goZdQ4-1cMas8MhCGAs9FVcS01Q3byPoAAjUO

  Both ischemic and hemorrhagic stroke may produce a thunderclap headache which can precede other stroke symptoms. […] A hypertensive crisis can precipitate a thunderclap headache. […] Posterior reversible leukoencephalopathy syndrome (PRES) is a consequence of uncontrolled hypertension. It is associated with thunderclap headache, vision loss, altered mental state, and, possibly, seizures. […] It is important to rule out the more serious causes of a thunderclap headache first, but there are also benign causes such as low cerebrospinal fluid (CSF) pressure, rapid onset migraine, post-coital headache, and exertional headaches. […] Half of all patients who have CSF low pressure headaches will present with a thunderclap headache elicited by assuming an upright posture. […] Rapid onset migraine is often referred to a crash migraine and the primary feature is the rapidity with which the headache reaches maximal intensity.

• #37 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. […] Serious causes of secondary thunderclap headaches include subarachnoid haemorrhage (SAH), cervical artery dissection, stroke, and a hypertensive crisis. […] 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. […] Note: SAH is the most common secondary cause of thunderclap headache and should be the focus of evaluation when thunderclap headache occurs. […] Both ischaemic and hemorrhagic stroke may produce a thunderclap headache which can precede other stroke symptoms.

• #38 Thunderclap headache • LITFL • Neurology library

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

  A hypertensive crisis can precipitate a thunderclap headache. […] It is important to rule out the more serious causes of a thunderclap headache first, but there are also benign causes such as low cerebrospinal fluid (CSF) pressure, rapid onset migraine, post-coital headache, and exertional headaches. […] Physicians are usually familiar with post lumbar puncture headaches caused by low CSF pressure. […] The hallmark is a positional headache which occurs and worsens when a patient is upright. […] Rapid onset migraine is often referred to a crash migraine and the primary feature is the rapidity with which the headache reaches maximal intensity. […] Post-coital headache, a thunderclap-like primary headache disorder, which can occur before or with orgasm. […] Exertional headaches are a primary headache disorder, with a thunderclap-type presentation, precipitated by any type of exercise or high-level physical activity.

• #39

  https://link.springer.com/article/10.1007/s00415-020-09728-0

  The subsequent headache, following the initial thunderclap, most frequently has clinical features consistent with migraine. […] Thunderclap, cough, exertional and sexual headache can occur as both primary and secondary headache disorders, the primary headaches predominating. […] Although thunderclap headache can occur spontaneously, it can also be triggered.

• #40 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. […] A diagnosis of a primary TCH can only be made if other diagnoses are excluded. […] However, there are many secondary causes of TCH, some of which can be serious. […] The main diagnostic feature of TCH is the rapidity with which they reach maximum intensity. […] Primary TCH is uncommon and should not have the symptoms of altered cognition and focal neurologic deficits. […] Consequently, patients with TCH require emergent evaluation. […] Approximately 10%-25% of patients with TCH have subarachnoid hemorrhage (SAH). […] In fact, the mortality of patients with SAH reaches 50%. […] The most common cause of spontaneous SAH is rupture of a saccular intracranial aneurysm.

• #41 A rare case of thunderclap headache | Eurorad

  https://www.eurorad.org/case/18068

  Regarding treatment modalities, against vasospasm, channel blockers have been utilised in the management of RCVS. […] In most cases, the prognosis for RCVS is positive, as clinical and angiographic abnormalities typically resolve within a few days to weeks and it depends on the development of stroke or haemorrhage, with probable neurologic impairments resulting in persistent disabilities or even death. […] RCVS is a transient cerebral vascular tone dysregulation that causes multifocal arterial constriction and dilation. […] The main clinical manifestation is intense recurrent thunder headaches lasting one to three weeks.

• #42 Thunderclap Headaches: Why You Should Watch Out for Sudden Onset of Pain — Migraine Again

  https://www.migraineagain.com/thunderclap-headaches/

  For a portion of people, thunderclap headaches can have no clear cause and can be what is considered benign, or not dangerous. […] It can be difficult to determine if a thunderclap headache is benign or serious, though, without a thorough evaluation. […] Since the biggest concern for a thunderclap headache is bleeding in and around the brain, usually the first step is obtaining a computerized tomography angiography (CTA) scan of the head to see if there is any blood in and around the brain. […] Thunderclap headaches are more intense, quicker to build, and the peak intensity lasts only for a few minutes. […] The severe head pain of a thunderclap headache only lasts about 60 seconds, but in rare cases like in RCVS the headache can come and go over several days to weeks. […] If the thunderclap headache does not have a cause, which can occur in a portion of cases, then often the headache will improve on its own; however, in these cases there are often recurrent thunderclap headaches. We call this primary thunderclap headache, meaning that this is a type of headache that comes on suddenly, at maximal intensity, without an underlying, potentially dangerous cause. […] Some studies have shown that treatment with the calcium channel blocker nimodipine can be helpful in reducing the chance of having a recurrence of thunderclap headache, though more studies are needed.

• #43 Thunderclap Headaches | American Migraine Foundation

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

  Depending on the age of the individual, a severe headache can occur hours to days after a mild-to-moderate head injury. […] In this often difficult-to-diagnose disorder, there is a temporary narrowing or spasming of a blood vessel surrounding the brain. […] Vasculitis, or blood vessel inflammation, comes from an autoimmune attack—that is, the body attacking its own blood vessels. […] In pregnancy, sudden new headaches may signal a number of different disorders, particularly late in pregnancy. […] Sudden, extreme head pain—even without other symptoms—can serve as a warning of a larger bleed or stroke to come. […] If doctors find no specific cause after a medical examination, they may then start treatment for what is called primary thunderclap headache, which is considered benign. […] If these headaches occur predictably at certain times, such as with sexual activity, then treating them with medication such as a non-steroidal anti-inflammatory (NSAID)—in particular, indomethacin—may be all that is needed. […] 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.

• #44 Thunderclap headache: The “worst headache of my life” – Harvard Health

  https://www.health.harvard.edu/blog/thunderclap-headache-the-worst-headache-of-my-life-2019062516939

  If no obvious cause is found, TCH is considered primary, or idiopathic. Primary TCH typically affects young adults. It is commonly associated with physical triggers such as cough, exercise, and sexual activity. […] Rarely, people can develop multiple, recurrent TCHs within a span of a few days. In such cases, imaging invariably shows alternating areas of narrowing and dilation (the appearance is described as a sausage on a string) of multiple brain arteries. This condition is called reversible cerebral vasoconstriction syndrome, or RCVS. […] Approximately 30% to 50% of patients with RCVS go on to develop brain hemorrhage, strokes, and brain swelling. […] There is no known preventive medication for primary TCH or RCVS. […] Certain medications should not be used to treat TCH. These include glucocorticoids, triptans, and other anti-migraine medications, which induce narrowing of brain arteries and can worsen the situation.

• #45 Reddit – The heart of the internet

  https://www.reddit.com/r/migraine/comments/154jplz/misdiagnosis_of_migraine_and_wrong_treatment/

  My friend recently gave birth. Two weeks ago she had a very sudden, severe head pain with vomiting that took her to ER to rule out a bleed on the brain. […] On reading more, it sounds more like thunderclap headache which are often caused by vasoconstriction. In most cases this is not life threatening. However, sumitriptan is contraindicated for this due to the fact it can have a vasoconstricting effect. […] I was surprised that she was given the diagnosis of a migraine and prescribed something that is contraindicated for her condition. Sumitriptan won’t help, can make the pain worse and could even be dangerous as it causes further vasoconstriction. For migraine this is helpful, but for TCH it is not.

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

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

  The outlook for a thunderclap headache depends entirely on its cause. […] In the most severe cases, thunderclap headaches may be due to a serious underlying medical condition, such as subarachnoid hemorrhage or a stroke. The outlook in these cases will depend on various factors, including the extent of the brain damage, and the persons overall health. […] A thunderclap headache refers to severe head pain with a rapid onset. It can be a sign of a serious underlying condition, such as a bleeding blood vessel in the brain. […] Anyone showing signs of a thunderclap headache must seek immediate medical attention. Depending on the cause, doctors may need to provide emergency treatments.

• #47 Thunderclap Headache | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30123

  The differential diagnosis includes other primary headache disorders and secondary TCH causes. […] The 2 most common causes of secondary TCH are SAH and RCVS. […] Approximately 10 to 18% of patients with SAH die before arriving at a hospital. […] Mortality at one year is 35 to 65%, and 25 to 33% of survivors will suffer reduced activities of daily living, decreased quality of life, and neurological disability. […] Importantly, „reversible” in the acronym RCVS refers to reversible vasoconstriction, not necessarily signs and symptoms associated with the syndrome. […] Most patients with RCVS have a self-limited course lasting days to weeks, with vasoconstriction usually resolving within 3 months. […] Overall, the long-term clinical outcomes associated with RCVS are excellent in over 90% of patients.

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

  https://practicalneurology.com/articles/2023-may-june/headaches-not-to-miss-regardless-of-the-patient-population-thunderclap-headache-in-the-emergency-department

  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 clinical presentation for people with CVST is related to increased intracranial pressure caused by obstruction of venous output or localized brain injury from venous ischemia or hemorrhage. […] 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. […] Thunderclap headache is the sole manifestation of RCVS in 75% of cases, typically lasting 1 to 3 hours in duration.

• #49 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/

  Acute onset of severe headache (ie, thunderclap headache) can be associated with oculomotor abnormalities (most commonly third cranial nerve palsy) or visual impairments (ie, bitemporal hemianopsia, exceptionally rare loss of visual acuity or vision altogether). […] The hallmark of spontaneous intracranial hypotension is an orthostatic headache, typically holocephalic or suboccipital (although it can be unilateral) that worsens when upright and attenuates while lying supine. […] Thunderclap headaches can occur with a variety of conditions that are associated with high debility, morbidity, and mortality.

• #50 Thunderclap headache: The “worst headache of my life” – Harvard Health

  https://www.health.harvard.edu/blog/thunderclap-headache-the-worst-headache-of-my-life-2019062516939

  Primary TCH can recur intermittently for several years. Recurrence of an episode of RCVS is extremely rare. Most people can resume routine physical activities and gradually increase the intensity of exercise two to four weeks after the sudden-onset headaches subside. […] The extreme head pain of primary TCH and RCVS can understandably evoke significant anxiety. But the long-term outcome is nearly always benign.

• #51 Reversible Cerebral Vasoconstriction Syndrome and Thunderclap Headaches: Understanding a Transient Neurological Event | Will Erwin Headache Research Foundation

  https://cureheadaches.org/2024/05/28/reversible-cerebral-vasoconstriction-syndrome-and-thunderclap-headaches-understanding-a-transient-neurological-event/

  There is no standardized treatment for RCVS, but management generally focuses on medications that dilate blood vessels and limiting potential triggers. […] The outlook for patients with RCVS is generally good, with most individuals having minimal headaches after 1 month, and no additional symptoms or blood vessel constriction after 3 months. […] Reversible Cerebral Vasoconstriction Syndrome, though often benign, is a significant cause of thunderclap headaches and can present with alarming neurological symptoms.

• #52

  https://link.springer.com/article/10.1007/s00415-020-09728-0

  This article reviews the disorders of thunderclap, cough, exertional and sexual headache. […] Thunderclap headache is the most frequently reported headache syndrome associated with a secondary pathology. […] The existence of a benign form of thunderclap headache is supported by longitudinal observations of patients investigated with normal CT and CSF examinations who did not develop any subsequent adverse sequalae and continued to experience recurrent attacks. […] In summary, TCH is the most common headache syndrome associated with a secondary precipitating pathology. The majority will have PTCH. […] Primary and secondary thunderclap headache, however, cannot be reliably differentiated clinically thus, all patients should be investigated. […] The current ICHD of primary thunderclap headache defines the rapidity of onset as being within 1 min.

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