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Thunderclap Headache


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]
  • Spontaneous intracranial hypotension presenting as thunderclap headache is recognized but rare.[ncbi.nlm.nih.gov]
Asymptomatic
  • Except for one patient with vasospasm in whom reversible posterior leukoencephalopathy and an asymptomatic cerebellar infarction developed, the others recovered without any complications.[ncbi.nlm.nih.gov]
  • Natural history of asymptomatic colloid cysts of the third ventricle. J Neurosurg. 1999;91(3):364–9. PubMed Google Scholar 189. Maeder PP et al.[doi.org]
Pseudotumor
  • […] mp. 10. exp acute disease/ and exp "headache and facial pain"/ 624 17 20 11. coit*.mp. and (headache/ or headache disorder/) 11. exp intracranial hypotension/ 589 8 11 12. call fleming.mp. 12. exp brain pseudotumor/ and exp "headache and facial pain"[doi.org]
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]
Throbbing Headache
  • 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]
  • Take Belladonna Belladonna is a homeopathic tincture which can be useful in treating thunderclap headaches, as well as other types of throbbing headaches. Speak to a naturopathic doctor or a licensed homeopath for details on how and when to take it.[askdrjj.com]
Slurred Speech
  • All presented with thunderclap headache, whereas half of them had additional neurologic symptoms such as right homonymous hemianopia, right-sided weakness, and slurred speech.[ncbi.nlm.nih.gov]
Memory Impairment
  • Short-term memory impairment in an alert patient as a presentation of herpes simplex encephalitis. Neurology. 1992 Jan; 42 (1):260–261. [ PubMed ] [ Google Scholar ] Raps EC, Rogers JD, Galetta SL, Solomon RA, Lennihan L, Klebanoff LM, Fink ME.[ncbi.nlm.nih.gov]
Convulsions
  • She subsequently developed hemi-convulsions followed by right hemiplegia. Brain magnetic resonance angiography revealed generalized vasoconstriction of the main cerebral peripheral arteries. Her hemiplegia was spontaneously resolved within 6h.[ncbi.nlm.nih.gov]
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]

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]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • We also offer pathophysiological considerations for primary TCH.[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]

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