Supplemental Content: Living Well with Migraine Disease and Headaches

Keep up with Migraine & headache news, tips, tools, and more... View our blog!


Thunderclap Headache - What Is It?

   

Thunderclap headache (TCH) refers to an excruciating headache of instantaneous onset—as sudden and as unexpected as a “clap of thunder.”3

The term "thunderclap headache" was first used to describe this headache as a symptom of an unruptured cerebral aneurysm. Since then, some other disorders have been noted to also present with TCH. Those disorders include:

  • subarachnoid hemorrhage (SAH),
  • cerebral venous sinus thrombosis (CVST),
  • pituitary apoplexy,
  • spontaneous intracranial hypotension (SIH),
  • hypertensive encephalopathy,
  • and retroclival hematoma.

In all of these cases, since the TCH is caused by another disorder, the headache is classified as a secondary headache.

When no organic cause is present, primary thunderclap headache may be diagnosed. Here are the description, diagnostic criteria, and other information from the International Headache Society's International Classification of Headache Disorders, 2nd edition, the gold standard for diagnosing and classifying headache disorders:

4.6 Primary thunderclap headache

Previously used terms: Benign thunderclap headache

Coded elsewhere:

4.2 Primary cough headache, 4.3 Primary exertional headache and 4.4 Primary headache associated with sexual activity can all present as thunderclap headache but should be coded as those headache types, not as 4.6 Primary thunderclap headache.

Description:
High-intensity headache of abrupt onset mimicking that of ruptured cerebral aneurysm.

Diagnostic criteria:

  1. Severe head pain fulfilling criteria B and C
  2. Both of the following characteristics:
    1. sudden onset, reaching maximum intensity in less than 1 minute
    2. lasting from 1 hour to 10 days
  3. Does not recur regularly over subsequent weeks or months (Note 1)
  4. Not attributed to another disorder (Note 2)

Notes:

  1. Headache may recur within the first week after onset.
  2. Normal CSF and normal brain imaging are required.

Comment:
Evidence that thunderclap headache exists as a primary condition is poor: the search for an underlying cause should be expedient and exhaustive. Thunderclap headache is frequently associated with serious vascular intracranial disorders, particularly subarachnoid haemorrhage: it is mandatory to exclude this and a range of other such conditions including intracerebral haemorrhage, cerebral venous thrombosis, unruptured vascular malformation (mostly aneurysm), arterial dissection (intra- and extracranial), CNS angiitis, reversible benign CNS angiopathy and pituitary apoplexy. Other organic causes of thunderclap headache are colloid cyst of the third ventricle, CSF hypotension and acute sinusitis (particularly with barotrauma). 4.6 Primary thunderclap headache should be the diagnosis only when all organic causes have been excluded.

As you can see from the comments in the IHS material, it is vitally important that all organic causes of TCH be ruled out before diagnosing primary TCH. Broner et al observed TCH as a presenting symptom of myocardial infarction (heart attack).2

Summary
Thunderclap headache is most commonly a symptom of an organic cause such as subarachnoid hemorrhage, cerebral venous sinus thrombosis, myocardial infarction, or others. Since these primary conditions can be life threatening, it is vitally important that all possible organic causes be carefully ruled out before diagnosing idiopathic or primary thunderclap headache.

For the patient who experiences TCH, it is essential to seek medical care immediately.

____________
Resources:

1 The International Headache Society. "The International Classification of Headache Disorders, 2nd edition." Cephalalgia 2004; 24 suppl 1:1-160.

2 Broner, Susan, MD; Lay, Christine, MD; Newman, Lawrence, MD; Swerdlow, Michael, MD. "Thunderclap Headache as the Presenting Symptom of Myocardial Infarction." Headache. 2007;47:724–725. DOI: 10.1111/j.1526-4610.2007.00795_1.x.

3 Dodick, David W., MD. "Thunderclap Headache." Headache. 2002;42:309-315

 

Follow me on    or 

Page copy protected against web site content infringement by Copyscape
© Teri Robert, 2011. Last updated February 9, 2011.

 

 

Living Well With Migraine Disease & Headaches continues to be a top listed title in bookstores and online booksellers. For a description on the book or an Amazon link, click HERE. To read an excerpt from my book or other content, check our Supplemental Content Section.

 

Remember:

Optimal health care can be achieved
only when patients are educated
about their health and patients and
physicians work together as
treatment partners in an
atmosphere of mutual respect.


Must-Reads:

 

 

 
Tell a friend about this article:

 The American Headache and Migraine Association (AHMA)...

a patient-focused, patient-driven organization for patients with Migraine and
other headache disorders and their family, friends, and care partners.
Anyone interested in the concerns or patients with these disorders is welcome to join.

The AHMA exists to EASE the burden of Migraine and other headache disorders through Education, Awareness, Support, and Engagement.

www.ahma.ws


 

This website is certified by Health On the Net Foundation. Click to verify.This site complies with the HONcode standard for trustworthy health information: verify here.
    

Search only trustworthy HONcode health websites:

NOTE: The information on this site is for education and support only. It is not medical advice and should not be construed as such. Always consult your physician if you have new or different symptoms. Never change your treatment regimen or add herbals, supplements, etc., without consulting your doctor.

All content on this site is physician reviewed by Dr. John Claude Krusz.

Our Mission & Purpose  •   About the Information on This Site  •   Our Privacy Policy  •   Site Funding, Advertising, & Linking  •   Contact

All content © 2004 - 2014, Teri Robert unless otherwise indicated. • All rights reserved.
Last updated Saturday, September 27, 2014.

Page copy protected against web site content infringement by Copyscape

 
     
 
advertisement  

Looking for awareness items? Your search is over...

"Headaches Do Not Have Me" Mug

from Cafe Press

"Not the Boss" Thermos Tea Tumbler

from Cafe Press

"Knowledge Is Power"
Tile Box

from Cafe Press

"Migraines Are Not the Boss of Me!"

from Cafe Press

 

You can find these and other items in our Awareness Shop!

advertisement

advertisement

Google
  Web www.helpforheadaches.com