Presentation
A small proportion of patients present acutely to a primary care doctor, and the main objective is to identify those who require urgent investigations. [doi.org]
Hypertensive encephalopathy with reversible posterior leukoencephalopathy can present as a thunderclap headache. [ncbi.nlm.nih.gov]
Musculoskeletal
- Osteophyte
Spontaneous intracranial hypotension due to intradural thoracic osteophyte with superimposed disc herniation: report of two cases. Eur Spine J. 2012;21 Suppl 4:S383–6. PubMed Google Scholar 144. Schievink WI et al. [doi.org]
Neurologic
- Throbbing Headache
Bathing headache is rarely described in literature. We report four middle-aged Taiwanese women who developed severe throbbing headache with maximum intensity of onset during bathing. Diffuse cerebral vasospasm was demonstrated in one of them. [ncbi.nlm.nih.gov]
While this won’t get rid of your thunderclap headache, it may at least reduce its severity. Take Belladonna Belladonna is a homeopathic tincture which can be useful in treating thunderclap headaches, as well as other types of throbbing headaches. [askdrjj.com]
- Truncal Ataxia
Her headache, vertigo, and truncal ataxia were completely improved one week later. [ncbi.nlm.nih.gov]
Workup
Initial workup for thunderclap headache to exclude subarachnoid or intracranial hemorrhage, meningitis, pituitary apoplexy, or venous sinus thrombosis was negative. [ncbi.nlm.nih.gov]
Microbiology
- Borrelia Burgdorferi
PubMed Central PubMed View Article Google Scholar Jacobi C, Schwark C, Kress B, Hug A, Storch-Hagenlocher B, Schwaninger M: Subarachnoid hemorrhage due to Borrelia burgdorferi-associated vasculitis. Eur J Neurol 2006, 13: 536–538. [doi.org]
Treatment
Nimodipine might be effective in treatment of this special headache syndrome. [ncbi.nlm.nih.gov]
Prognosis
Treatment and prognosis depend on the etiology of the TCH. [ncbi.nlm.nih.gov]
Idiopathic thunderclap headache with vasospasm must also be distinguished from inflammatory CNS vasculitis, as the outcome, management, and prognosis are different. [doi.org]
Etiology
Subarachnoid hemorrhage is the most commonly identified etiology for this headache, however, other secondary etiologies should be considered. [ncbi.nlm.nih.gov]
There are numerous etiologies of thunderclap headache, some associated with substantial morbidity and mortality and others with benign outcomes. [headachejournal.onlinelibrary.wiley.com]
Numerous etiologies for thunderclap headaches have been identified, with the most common causes being subarachnoid hemorrhage and reversible cerebral vasoconstriction syndrome. [journals.lww.com]
Epidemiology
There is a need for an up to date population based description of cause of sudden and severe headache as the modern epidemiology of thunderclap headache may require updating in the light of research on cerebral vasoconstriction syndromes. [ncbi.nlm.nih.gov]
It is not usually necessary to proceed to cerebral angiography, a more precise but invasive investigation of the brain's blood vessels, if MRA and MRV are normal. [1] Epidemiology [ edit ] Incidence of thunderclap headache has been estimated at 43 per [en.wikipedia.org]
A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study. Stroke. 2000;31(5):1054–61. PubMed Google Scholar 20. Inagawa T et al. [doi.org]
To gain insights into the epidemiology, clinical range, pathophysiology, appropriate management, and prognosis of patients with this disorder, clinical criteria must be established to create homogenous patient populations to study in a prospective fashion [dx.doi.org]
Pathophysiology
The pathophysiology of this disorder in the absence of underlying pathology is not well understood and its potential angiographic features are not well appreciated. Two case descriptions with illustrative angiography. [ncbi.nlm.nih.gov]
PATHOPHYSIOLOGY The pathophysiology or mechanism(s) underlying idiopathic thunderclap headache with or without segmental vasospasm is unclear. [doi.org]
Prevention
Include Blood-Thinning Vegetables Garlic, onions, and peppers are all known to act as blood thinners, which can help prevent blood clots as well as reduce their severity. Because thunderclap headaches can be caused by blood clots, this makes sense. [askdrjj.com]
However, when cerebral vasospasm is present, careful clinical monitoring is important and although the evidence is purely anecdotal, nimodipine may be used in an attempt to prevent or ameliorate the risk of a delayed ischaemic deficit. 45 Although these [doi.org]
Assessment: Prevention of post-lumbar puncture headaches: Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology. 2000; 55 :909–14. [ PubMed ] [ Google Scholar ] 11. Vermeulen M, van Gijn J. [ncbi.nlm.nih.gov]