Thunderclap headache is sudden in onset but severe in intensity and is stated as “the worst headache” ever experienced by individuals. The pain can be felt anywhere in the head, sometimes even in the neck and back. Thunderclap headache due to carotid artery dissection mostly presents with headache in half of the head.
As the name suggests, the headache strikes like thunder, without any warning, signaling towards a medical emergency that needs immediate attention.
Symptoms of thunderclap headache
Since the onset of headache is sudden and the time duration is short, there are no specific associated symptoms. Sometimes headache is followed by:
- Confusion
- Nausea
- Vomiting
- Numbness and weakness
- Seizures
- Changes in vision or sensations
- Fever
Headache has an abrupt onset and peaks for sixty seconds. Then, it starts fading away and may vanish in an hour. In some cases may last for up to a day or two.
Any of these should be addressed as soon as possible.
Causes of thunderclap headache
There are several possible causes of thunderclap headaches and their consequences are grave.
1. Decreased blood flow to the brain:
An aneurysm weakens the blood vessel wall, making it prone to tears and rupture. Any sort of injury, trauma or even exertion can cause the vessel to rupture and bleed profusely in the form of a hemorrhage. Resulting in reduced blood flow towards the brain and a headache.
2. Hemorrhagic stroke:
In hypertensive patients, with uncontrolled high blood pressure, a blood vessel in the brain can rupture causing a subarachnoid hemorrhage. Excessive loss of blood may lead to a stroke.
3. Ischemic stroke:
In some atherosclerotic patients, the blood vessels to the Brain may become stenosed due to excessive deposits of cholesterol and eventually block the blood flow towards the brain. Eventually causing severe pain and loss of sensation, vision, or consciousness.
4. Thunderclap headache after trauma:
In some cases, patients report with a thunderclap headache, few days after a traumatic injury. Here the cause might be a thrombus that has become an embolus and might have blocked an artery. Another possible cause is a subdural hematoma/bleed in older individuals and an epidural hematoma or bleeding in young individuals.
5. Reversible Cerebelllar Vasoconstriction Syndrome (RCVS):
The mechanism behind this disorder is still unknown. But vasospasm causes temporary vasoconstriction of vessels supplying to the brain. This decreases the blood supply to the brain, hence the headache. The vessels might appear normal in an MRI Scan as this condition is only temporary.
Other causes include:
- Rapid and drastic changes in blood pressure
- Spinal leak as a result of a spinal tap or an injury
- Inflammation of blood vessels (arteritis)
- Pre-eclampsia of pregnancy
- Arterial dissection in small arteries of the brain
- An infection that has spread to the brain
What triggers a thunderclap headache?
It doesn’t have a specific cause yet, some of the things that can trigger an attack are:
- Trauma
- Physical exertion
- Increased pressure during bowel movement
- Sexual activity
Complications of thunderclap headache
A thunderclap headache can indicate several life-threatening complications that may prove fatal if not addressed immediately:
- Stroke
- Trauma to skull
- Hemorrhage
- Increased intracranial pressure
Thunderclap headache and migraine
A thunderclap headache doesn’t feel anything like a migraine. However, people who have migraines have most commonly experienced thunderclap headaches. The major difference is the intensity of pain between the two. It is the worst headache anyone would have ever experienced while pain in migraine is still bearable.
Diagnosis
A thunderclap headache is often life-threatening and should be diagnosed as early as possible. Your doctor may begin by asking questions regarding the intensity, frequency, and duration of your head. Some of the tests that would help in making a stable diagnosis are:
- Xray to look for any sort of fracture in case of trauma
- Ct scan and an MRI to get better images of the brain to find out any hemorrhage or thrombus
- Magnetic resonance angiography to get detailed images of blood vessels in the scalp and brain
- A spinal tap to rule out increased intracranial pressure or any sort of meningeal infection
How to prevent a thunderclap headache?
- Since the headache is associated with some underlying conditions, and they come unexpectedly, without any warning. Thus, only the underlying conditions can be taken care of.
- Individuals with a family history of heart diseases should make lifestyle modifications; improve their dietary habits and do exercises.
- Hypertensive people should monitor their blood pressure and keep it under safe limits.
- Avoid any sort of trauma if you are hypertensive already.
Treatment of thunderclap headache
- This is treated according to the cause. In case of an emergency, your doctor might give you an NSAID to reduce the swelling (inflammation) before carrying on with the rest of the treatment.
- If the headache is caused by a thrombus- anticoagulants would be given.
- In case of a ruptured vessel or severe hemorrhage, your doctor might have to operate on you to treat the cause.
FAQ
How long does a thunderclap headache last?
Headache has an abrupt onset and peaks for sixty seconds. Then, it starts fading away and may vanish in an hour. In some cases may last for up to a day or two.
How can I prevent a thunderclap headache?
- Since the headache is associated with some underlying conditions, and they come unexpectedly, without any warning. Thus only the underlying conditions can be taken care of.
- Individuals with a family history of heart diseases should make a lifestyle modifications; improve their dietary habits and do exercises.
- Hypertensive people should monitor their blood pressure and keep it under safe limits.
I suffered from a whiplash injury two days back, now I have a severe headache, what can it possibly be?
In some cases, patients report with a thunderclap headache few days after a traumatic injury. Here the cause might be a thrombus that has become an embolus and might have blocked an artery. Another possible cause is a subdural hematoma/bleed in older individuals and an epidural hematoma or bleeding in young individuals.
What is the location of pain for a thunderclap headache?
There is no specific location of pain. The pain can be felt anywhere in the head, sometimes even in the neck and back. Thunderclap headache due to carotid artery dissection mostly presents with headache in half of the head.
