- Potential Causes
- Signs and Symptoms
- Diagnostic Tests
- Treatment Options
Thunderclap headache (TCH) is a term introduced to describe the apoplectic onset of a headache that begins suddenly, without warning and peaks with severe intensity within seconds. A person often describes this headache as “the worst headache of my lifetime.”
Thunderclap headache appears as an extremely painful headache, reaching at least 7 out of 10 in intensity (on a pain scale) within a minute of its onset, and each episode can last for at least five minutes. This headache is typically a symptom of several conditions that have the potential for significant morbidity and mortality.
What is the cause of a thunderclap headache?
Most causes of thunderclap headache result from a problem with the blood vessels around the brain, due to injury or heavy exertion.
Furthermore, the main causes of thunderclap headache include:
- Torn or ruptured brain blood vessels
- Stroke (blocked or bleeding blood vessel)
- A brain aneurysm (bulging or bleeding blood vessel)
- Head injury that causes a brain bleed
- Vasculitis (swollen blood vessel)
- Infections occurring in the brain, such as encephalitis or meningitis
- A sudden severe rise in blood pressure
- Pregnancy complications, including a rise in blood pressure and bleeding in the brain’s pituitary gland during labor
- Spasms in the blood vessels surrounding the brain (vasoconstriction syndrome) or severe vascular migraine
What are the signs and symptoms of a thunderclap headache?
The key symptom of a thunderclap headache is sudden and severe pain in the head. This pain reaches its most intense peak within 60 seconds and lasts for at least five minutes.
Other symptoms of a thunderclap headache may include:
How is thunderclap headache diagnosed?
The tests that are commonly being used to determine the cause of a thunderclap headache include:
- Computed tomography or CT scan of the head. CT scans use X-rays to create slice-like, cross-sectional images of the head and brain. A monitor combines these images to create a full picture of the brain. On some occasions, an iodine-based dye is used to augment the picture.
- Spinal tap (lumbar puncture). The health professional removes a small amount of the fluid surrounding the brain and spinal cord. The cerebrospinal fluid sample can then be tested to verify any signs of bleeding or infection.
- Magnetic resonance imaging or MRI. In some cases, this imaging study is recommended for further assessment. A magnetic field and radio waves are used to capture the cross-sectional images of the structures in the brain. It may show blood vessel lesions.
- Magnetic resonance angiography or MRA. This test may use MRI machines to locate the blood flow inside the brain.
What is the treatment of thunderclap headache?
The treatment option for thunderclap headache is determined based on its cause. Treatments are mainly targeted to treat the cause of the headache, which may include:
- Intravenous or oral nimodipine (a calcium channel blocker) can be administered if the thunderclap headache is caused by spasms in the brain’s blood vessels.
- Medications to control blood pressure.
- Sometimes, surgery may be required to repair torn or ruptured blood vessels or remove a blockage to cure a thunderclap headache.
- Pain medications to manage recurrent thunderclap headache that is associated with a specific trigger.
- Also, managing underlying health conditions and avoiding triggers are the best ways to prevent them from occurring frequently. Maintaining a healthy diet and active lifestyle helps keep blood pressure from rising to levels that could cause a condition, which may precipitate a thunderclap headache.
- Quitting smoking and controlling cholesterol levels help to reduce the risk of blood vessel problems.
Health Solutions From Our Sponsors
Dodick DW. Thunderclap Headache. J Neurol Neurosurg Psychiatry. 2002;72:6-11. https://jnnp.bmj.com/content/72/1/6
Sekhon S, Sharma R, Cascella M. Thunderclap Headache. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 https://www.ncbi.nlm.nih.gov/books/NBK560629/
Linn FH. Primary thunderclap headache. Handb Clin Neurol. 2010;97:473-81. https://pubmed.ncbi.nlm.nih.gov/20816448/
Top How Long Does Headache Last After Thunderclap Related Articles
Can NMO Cause Headaches?Neuromyelitis optica (NMO) also known as Devic disease is a rare yet severe disease. In this condition, antibodies (proteins) are produced against the cells in the central nervous system. It specifically affects the myelin, which is the insulation sheath around the nerves.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Headache Home RemediesHeadaches are a common complaint for many people. There are many types of headaches such as migraine, tension, cluster, and the general run of the mill headache. These 17 natural home remedies -- for example, exercise, meditation, hydration, yoga, caffeine, essential oils such as lavender and butterbur, herbs, and supplements like magnesium -- can soothe and relieve some headaches.
Headaches QuizIf you're plagued with headaches, our Headaches Quiz may help you identify causes, triggers, symptoms, and treatments for headache pain caused by different types of headaches such as migraines, sinus, cluster, tension, or stress.
Migraine HacksA migraine can be more than just a whopping headache. Try these self-care tips for relief before and after it hits.
Migraines SlideshowWhat does a migraine headache feel like compared to a tension headache? Learn to spot migraine symptoms early, how to identify your triggers, and get more information on migraine headache medications and treatments. Learn to tell migraine from other types of headaches.
Migraine vs. Headache: Differences and SimilaritiesHeadaches are the most common reason why a person goes to the doctor or other healthcare professional for treatment. There are different types of headaches, for example, migraine, tension, and cluster headaches. The most common type of headache is tension headache. Migraine is much less common. There are few similarities between migraine and other headaches, for example, the severity of the pain can be the same, mild, moderate, or severe; and they can occur on one side or both sides of the head. However, there are many differences between migraine and other types of headaches. Migraine headaches also have different names, for example, migraine with aura and menstrual migraine.
Symptoms of migraine that usually aren't experienced by a person with another type of headache include nausea, vomiting, worsens with mild exercise, debilitating pain, eye pain, throbbing head pain.
Migraine trigger include light, mild exercise, strong smells, certain foods like red wine, aged cheese, smoked meats, artificial sweeteners, chocolate, alcohol, and dairy products, menstrual period, stress, oversleeping, and changes in barometric pressure.
Untreated migraine attacks usually last from 4 to 72 hours, but may last for weeks. Most headaches resolve within 24-48 hours. Doctors don't know exactly what causes migraine headaches; however, other headaches like tension headaches have more specific triggers and causes. Additional tests usually are required to diagnose migraine from other types of headaches, diseases, or other medical problems. Most headaches can be treated and cured with home remedies like essential oils, massage, and over-the-counter pain medication like acetaminophen (Tylenol) and NSAIDs (nonsteroidal anti-inflammatory drugs) like naproxen (Aleve, Anaprox, Naprosyn) or ibuprofen (Advil, Midol, Motrin). Most headaches resolve with OTC and home remedy treatment, while your doctor may need to prescribe medication to treat your migraines. If you have the "worst headache of your life," seek medical care immediately.
Non-Drug Migraine HelpLearn about 14 non-drug treatments for migraines. Acupuncture, biofeedback and massage therapy are among this list of non-drug migraine treatments that may help ease pain.
Is It Normal to Have Headaches in Second Trimester Pregnancy?Many women experience headaches during pregnancy. Headaches tend to be worse during the first trimester and they get better in the second and third trimesters although some women still experience headaches during the second trimester.
What Are the Causes of a Headache Behind the Eyes?A headache behind the eyes is an uncomfortable sensation that is felt around or on the back of the eye, which may or may not be a throbbing ache. Causes of headaches behind the eyes include tension headaches, migraines, cluster headaches, sinus headaches, occipital neuralgia, brain aneurysm, Grave's disease, scleritis, dry eyes, vision problems, eye strain and poor posture.
What Are the Different Types of Headaches?Pain originating in any region of the face, head or neck is called headache. This pain can be dull or severe and localized to the face, skull or neck. The head is the most common site of pain in the body. Types include tension headache, migraines, cluster headaches and others.
What Causes Headaches at the Back of the Head?Headaches in the back of the head can have a number of different causes; it might only be due to a minor injury or it can be a secondary symptom of other problems in the body. The type and location of the pain can play a crucial role in diagnosing the cause of headaches.
What Does a Pseudotumor Cerebri Headache Feel Like?Pseudotumor cerebri headaches usually feel like a headache that occurs at the back of the head or behind the eyes. The pain starts as a dull, aching pain that worsens at night or in the morning. They may be associated with vomiting as well. Patients may also eventually develop visual problems and blindness due to inflammation of the optic nerve.
What Triggers Tension Headaches?A tension headache is the most common type of headache seen in adults. A tension headache is also called a tension-type headache (TTH) or stress headaches. It is usually associated with muscle tightness in the head, scalp or neck. A tension headache is so common that we often consider it a normal occurrence. There are two types of tension headaches: Episodic tension headaches and chronic tension headaches.