thunderclap headaches
Thunderclap headache is an extremely painful headache that begins suddenly and peaks with intensity within seconds. These headaches can last for at least 5 minutes.

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:

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.

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Medically Reviewed on 8/23/2021
References
Singhal A. Thunderclap Headache: The “worst headache of my life.” Harvard Health Publishing. https://www.health.harvard.edu/blog/thunderclap-headache-the-worst-headache-of-my-life-2019062516939

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/