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Thunderclap Headache: Overview, Causes, Signs and Treatment

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OVERVIEW

A thunderclap headache is a severe headache that starts suddenly, like a clap of thunder. The pain does not build up gradually: it reaches its peak within about one minute and lasts at least five minutes.

It is a medical emergency. A thunderclap headache can be a sign of bleeding in the space around the brain (subarachnoid hemorrhage), most often from a ruptured brain aneurysm. If you have one, call 911 or go to the nearest emergency room right away.

Not every thunderclap headache comes from bleeding. Doctors still need to check quickly for a dangerous cause, because the first hours matter.

Causes of Thunderclap Headache

The most feared cause is a subarachnoid hemorrhage. A leading cause of this bleeding is a ruptured aneurysm, a weak, bulging spot in an artery wall.

These berry-shaped (saccular) aneurysms usually form where arteries branch at the base of the brain, in an area called the circle of Willis. Common sites include the anterior communicating artery, posterior communicating artery and middle cerebral artery.

Other causes include reversible cerebral vasoconstriction syndrome (RCVS), in which brain arteries temporarily narrow. A review of RCVS notes it can be triggered by exertion, sex, straining, certain drugs and the period after childbirth. Bleeding from other vessels, a tear in an artery in the neck, a blood clot in the brain's veins, stroke and very high blood pressure can also cause it.

Risk factors for a subarachnoid hemorrhage include an aneurysm in the family, polycystic kidney disease, connective tissue disorders such as Ehlers-Danlos syndrome, high blood pressure, smoking and cocaine or methamphetamine use.

8 Essential Oils For Headache You Must Try

Essential oils and home remedies are not a treatment for thunderclap headache. A ruptured aneurysm is life-threatening, so emergency care comes first.

Signs and Symptoms

  • The main symptom of a subarachnoid hemorrhage is a sudden, severe headache, often worse near the back of the head. Many people call it "the worst headache ever."
  • The headache may start after a popping or snapping feeling in the head.
  • Nausea, vomiting, a stiff neck and neck or shoulder pain are common.
  • It can start during straining, sex or physical exertion, and some people lose consciousness.
  • People may be confused or irritable and sensitive to light (photophobia).
  • A stiff neck can take a few hours to develop. Some people have trouble speaking.
  • Vision problems such as double vision, a drooping eyelid or unequal pupil sizes can occur if an aneurysm presses on nearby nerves.

Other possible symptoms include seizures, numbness and weakness on one side of the body.

Laboratory Examination

  • CT scan

A head CT scan without contrast dye is done right away. It shows blood in the space around the brain in most people, especially in the first hours.

A normal CT scan does not completely rule out a bleed, because a small amount of blood can be missed.

  • Lumbar puncture

If the CT scan is normal, doctors may do a lumbar puncture (spinal tap) to look for blood or its breakdown products in the spinal fluid. A yellow color called xanthochromia suggests a subarachnoid hemorrhage.

The timing and safety of this test depend on the CT results and the person's condition, so doctors decide case by case.

  • Cerebral angiography

If a bleed is found, imaging of the brain's blood vessels, such as CT angiography or cerebral angiography, shows where the aneurysm is so it can be repaired. MRI and MR angiography are sometimes used as well.

Supportive Therapy

People with a subarachnoid hemorrhage are cared for in a hospital, often in intensive care. Supportive care may include:

  • strict bed rest and avoiding straining, bending over or sudden position changes
  • IV fluids and medicines through an IV line
  • stool softeners or laxatives to prevent straining
  • pain relief and medicines to ease anxiety
  • protecting the airway and, if needed, life support

How To Treat Thunderclap Headache?

Treatment depends on the cause. For a subarachnoid hemorrhage from an aneurysm, the goals are to save the person's life, stop the bleeding, prevent it from happening again and prevent complications.

  • Nimodipine

Doctors give a medicine to help prevent dangerous spasms of the brain's arteries after the bleed. Nimodipine is commonly used for this, with the dose and timing set by the hospital team.

  • Insertion of platinum coils

The aneurysm can be repaired by endovascular coiling, in which a catheter places tiny coils inside the aneurysm to seal it off. Another option is surgical clipping through an opening in the skull. Both carry some risk of complications.

  • Arteriovenous malformations

If bleeding comes from an arteriovenous malformation (AVM), a tangle of abnormal blood vessels, it may be treated with surgery or with procedures done through a catheter to block the abnormal vessels.

  • Control of hypertension

Blood pressure is often high after a bleed. Medicines given through an IV help control it and lower the risk of more bleeding.

  • Seizures prophylaxis

Seizures can occur after a subarachnoid hemorrhage. Doctors may give medicines to prevent or treat them.

  • Reduce cerebral edema

If pressure builds up inside the skull, doctors may place a drain to remove fluid and use medicines to reduce swelling.

Prognosis of Thunderclap Headache

The outlook depends on the cause. For a subarachnoid hemorrhage, it depends on the amount and location of bleeding, the person's age, how severe the symptoms are and whether complications occur.

Some people recover completely with fast treatment, while others are left with lasting problems or die, even with treatment. Thunderclap headaches from RCVS often improve over weeks to months, though serious complications can occur.

Complications of Thunderclap Headache

The most serious complication of a subarachnoid hemorrhage is bleeding again from the aneurysm. Changes in alertness can also worsen and lead to coma or death.

Few of the Other complications which the patient may suffer are:

  • spasm of the brain's arteries, which can cause a stroke
  • hydrocephalus (a buildup of fluid in the brain)
  • seizures
  • low sodium levels (hyponatremia)
  • trouble speaking (aphasia)
  • weakness or paralysis
  • side effects of medicines and blood clots from bed rest

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CONCLUSION

A thunderclap headache is a sudden, severe headache that peaks within about a minute. It is often caused by bleeding in the space around the brain, usually from a ruptured berry aneurysm in the circle of Willis.

It is an emergency. Call 911 or go to the nearest emergency room right away; don't wait to see if it goes away.

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