Causative & risk factors
Thunderclap headaches are usually produced as a result of underlying vascular or brain disease. Common causes include subarachnoid hemorrhage, cerebral aneurysms, spontaneous intracranial hypotension and reversible cerebral vasoconstriction syndrome. Presence of thrombosis or hematoma in the brain or hypertensive crisis can also produce thunderclap headaches.
These headaches can sometimes be idiopathic, wherein no underlying cause is detected. Thunderclap headaches in which no cause is found are termed as primary, whereas those with an underlying cause are termed as secondary.
Clinical presentation
Thunderclap headaches begin suddenly and reach their peak intensity within seconds. The pain can be located anywhere in the head and neck. They can last for an hour or even up to a period of several days. Nausea and/or vomiting may be present in association with the headache.
Investigations
Imaging tests such as CT, MRI scan or an MR angiography is done to detect the underlying cause for thunderclap headache. A spinal tap may be performed to examine the CSF (cerebro-spinal fluid).
Treatment
If an underlying cause is found, treatment will be aimed at treating the cause. In case of idiopathic thunderclap headaches, pain relief can be achieved with the help of medications.
