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Thunderclap Headaches

Definition:
Thunderclap headaches live up to their name, grabbing your attention like a boom of thunder. The pain of these sudden, severe headaches peaks within 60 seconds and usually fades over several hours. A less severe headache may linger for up to 10 days.

Thunderclap headaches are uncommon. Although they may appear for no obvious reason, prompt diagnosis is important. Some thunderclap headaches have serious underlying causes, such as bleeding in the brain.

Causes:
Some thunderclap headaches appear for no obvious reason. These are referred to as idiopathic thunderclap headaches. In other cases, potentially life-threatening conditions may be responsible, including:
  • Bleeding between the membranes covering the brain and the brain itself (subarachnoid hemorrhage)
  • Bleeding into the brain caused by the rupture of a blood vessel (intracerebral hemorrhage)
  • A bulge in a blood vessel in the brain that ruptures (cerebral aneurysm)
  • A blood clot in the sinuses in the brain (cerebral venous sinus thrombosis)
  • A tear in the lining of an artery in the neck that supplies blood to the brain (carotid artery dissection)
  • A tear in the membrane that surrounds the brain and spinal cord, leading to a leak of spinal fluid
  • Death of tissue or bleeding in the pituitary gland (pituitary apoplexy)
Risk Factor:
Thunderclap headaches may be more likely in women older than 45.

When to seek medical advice:
Seek immediate medical attention for any headache that comes on suddenly and severely.

Symptoms:
Seek immediate medical attention for any headache that comes on suddenly and severely.

Dignosis:
Diagnosis often starts with a computed tomography (CT) scan of the head to search for an underlying cause for the headache. Computerized tomography uses an X-ray unit that rotates around your body and a computer to create cross-sectional images (like slices) of your brain and head.

Sometimes a spinal tap (lumbar puncture) is needed as well. With this procedure, the doctor removes a small amount of the fluid that surrounds your brain and spinal cord. The cerebrospinal fluid sample can be tested for protein, white blood cells and other substances.

In some cases, magnetic resonance imaging (MRI) may be done for further assessment. With this imaging study, a magnetic field and radio waves are used to create cross-sectional images of the structures within your brain.

The doctor may use a cerebral angiogram to search for a possible cerebral aneurysm. During this X-ray test, the doctor inserts a thin, flexible tube into a large artery — usually in the groin — and threads it past the heart into the arteries in your brain. A dye injected through the catheter fills the arteries to make them visible by X-ray.

Complication:
Thunderclap headaches aren't associated with any complications, but some underlying causes can be life-threatening.

Treatment:
There's no specific treatment for recurring thunderclap headaches. Oral pain relievers don't work quickly enough to ease the sudden, intense pain. If necessary, your doctor may prescribe other types of medication to stop the pain.

If bleeding in the brain is causing the headache, emergency surgical treatment may be needed.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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