Thunderclap Headache: symptoms, causes and treatments

A thunderclap headache is a severe headache that comes all of a sudden, taking seconds or minutes to reach its maximum. It can indicate any medical problem, such as a life-threatening condition called subarachnoid hemorrhage.

The term was introduced in 1986 by John Day and Neil Raskin, neurologists at the University of California, San Francisco.

Signs and symptoms

As aforementioned, a headache is classified as "thunderclap headache", if the person experiences headache of immense intensity that reaches its maximum intensity within seconds or minutes.

- Suddenly striking severe pain in head.
- Reaches maximum intensity within a minute
- Lasts for an hour up to 10 days
- Sometimes accompanied with nausea and vomiting
- Occurs usually in the head or neck


In general, thunderclap headache is not associated with any abnormality, and it usually tends to arise from:

1. Subarachnoid haemorrhage: There is brief loss of consciousness (syncope), seizure, neck pain with stiffness (meningism), visual problems and vomiting. Such headache may persist for several days. Subarachnoid haemorrhage accounts for 10-25% of thunderclap headache.

2. Cerebral venous sinus thrombosis: Blood clots form blood vessel in the brain that indicates raised intracranial pressure, acts like coughing intensifies the condition.

3. Cervical artery dissection: Tears form in the blood vessels that lead to the brain, Additional symptoms include pain of the affected side on head or neck, visual problems, any particular abnormality related to the affected vessel.

Other causes include:

- Very high blood pressure (Hypertensive emergency)
- Low pressure on the cerebrospinal fluid (spontaneous intracranial hypotension)
- Stroke
- Retroclival hematoma : Blood collects locally within the tissue, behind the clivus in the skull; usually caused due to physical trauma.
- Pituitary apoplexy (damage to pituitary gland)
- Cyst in the brain (colloid cyst)
- Call-Fleming syndrome or Reversible cerebral vasoconstriction syndrome

Some of these headaches can last for more than a week. They can be an early sign of potentially life-threatening conditions, such as bleeding in and around the brain.

Conditions like excess exertion, sex or cough can also cause thunderclap headache, but it is usually not life-threatening and goes within about 30 minutes.


Initially, computed tomography of the brain is carried out to trace for subarachnoid hemorrhage. If this comes normal, next is lumbar puncture carried out to test xanthochromia. Other tests include MRI and MRA to identify problems with arteries; and MRV to check for venous thrombosis.

If the above tests are normal cerebral angiography is carried out which offers a more precise investigation of the brain's blood vessels.


It depends upon the diagnosis. For example, if caused by meningitis, there are additional signs of stiff neck or strange red marks on the skin, the patient gets treated for meningitis.

Lumbar puncture or spinal tap is conducted to examine cerebro-spinal fluid which can indicate infection or internal bleeding.

Painkillers and other medications are administered. Surgery may also be carried out depending upon the case.

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