Thunderclap Headache: Causes, Symptoms, Signs, Investigations, Treatment

Thunderclap headaches, as the name itself suggests, occur all of a sudden catching the patient unawares. The pain is not only sudden in nature, but also very severe and reaches its peak intensity within a minute. These headaches can start receding after one hour or so. There are some thunderclap headaches, which may last for over a week.

Thunderclap headaches are relatively rare, but whenever the patient is experiencing such type of headache, then he/she should not ignore it, as they may be an indication of life-threatening conditions, such as internal bleeding or bleeding around the brain. Hence, immediate medical attention should be sought if you are experiencing a thunderclap headache.

Thunderclap headaches can occur without any obvious cause; however, they can also be caused by potentially life-threatening conditions, such as:

• Internal bleeding in the brain and within the membranes which cover the brain.
• A ruptured blood vessel in the brain.
• Any tear in (the lining of any of the arteries, such as carotid or vertebral artery, which supply blood to the brain.
• Any tear in the covering of a spinal nerve root can lead to cerebrospinal fluid leakage, which in turn results in a thunder clap headache.
• Presence of a tumor in the third ventricle of the brain can hinder the course of cerebrospinal fluid and cause thunder clap headache.
• Any bleeding internally in the pituitary gland or necrosis (tissue death).
• If the brain has a blood clot.
• Extremely high blood pressure (hypertensive emergency).
• Infections like encephalitis or meningitis.
• Stroke

• Patient experiences a sudden and extremely intense headache.
• The headache escalates rapidly and reaches its peak intensity within a minute.
• It can persist for an hour or up to 10 days.
• These headaches can occur in the head or in the neck region.
• Nausea or vomiting may also be present with the headache.
• There may also be weakness or visual impairment.
• If the cause is subarachnoid hemorrhage, then the patient may lose consciousness and also have seizures, neck pain and stiffness, visual disturbances and vomiting.

• CT scan: Computerized tomography scans of the head help in identifying the underlying cause of the headache. An iodine-based dye is also sometimes used to enhance the image.
• Spinal Tap: Also known as lumbar puncture can also be done in some cases. In this procedure, a small amount of fluid which surrounds the brain and spinal cord is removed and this sample is tested for any infection or bleeding.
• MRI: Magnetic Resonance Imaging (MRI) helps in more detailed assessment of the structures present inside the brain.
• Magnetic Resonance Angiography (MRA): This test helps in mapping the blood flow inside the brain.

Treatment depends on the underlying cause of the headaches and is done accordingly. There are many causes of thunderclap headaches, so it’s very important to arrive at a correct diagnosis in order to treat them properly. The above mentioned tests need to be done to find out the exact cause of the headache, so that appropriate treatment could be started. Treatment may include use of prescription medications, therapeutic lumbar puncture and even surgery in serious cases. If the patient is vomiting, then I.V. painkillers are given. Surgery is required if a blood clot is the cause of headache. If the cause of thunderclap headache is found to be meningitis, then treatment is done accordingly with antibiotics.

So, there is no definite treatment for thunderclap headaches, as the treatment totally depends on the cause of headache.