Presentation
Hypertensive encephalopathy with reversible posterior leukoencephalopathy can present as a thunderclap headache. [ncbi.nlm.nih.gov]
Cardiovascular
- Thrombosis
Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis. Stroke. 2000;31(6):1274–82. PubMed Google Scholar 104. Martinelli I. Cerebral vein thrombosis. Thrombosis Res. 2013;131:S51–4. Google Scholar 105. [doi.org]
The headache typically persists for several days. [1] Cerebral venous sinus thrombosis, thrombosis of the veins of the brain, usually causes a headache that reflects raised intracranial pressure and is therefore made worse by anything that makes the pressure [en.wikipedia.org]
Cerebral venous thrombosis. A review of 38 cases. Stroke 1985 ; 16 : 199 –213. ↵ Barinagarrementeria F, Cantu C, Arredondo H. Aseptic cerebral venous thrombosis: proposed prognostic scale. [dx.doi.org]
- Hypotension
Spontaneous intracranial hypotension presenting as thunderclap headache is recognized but rare. [ncbi.nlm.nih.gov]
Spontaneous intracranial hypotension: recommendations for management. Can J Neurol Sci. 2013;40(2):144–57. An excellent review on Spontaneous Intracranial Hypotension including guidelines on diagnosis and management. Google Scholar 127. [doi.org]
- Vascular Disease
Complications of intraarterial digital subtraction angiography in patients investigated for cerebral vascular disease. [ncbi.nlm.nih.gov]
Complications of intraarterial digital subtraction angiography in patients investigated for cerebral vascular disease. Br J Radiol 1993 ; 66 : 855 –85. [doi.org]
However, migraine can be considered an important risk factor for hypertensive and vascular diseases during pregnancy [90]. [thejournalofheadacheandpain.biomedcentral.com]
Musculoskeletal
- Neck Pain
In stroke among young patients or stroke with pain in the head and neck, angiography study of the craniocervical artery is highly recommended. [ncbi.nlm.nih.gov]
But he then developed severe neck pain and crushingly painful headaches, each of which lasted just a few seconds, over the next several days. [sciencedaily.com]
[…] on the affected side of the head or neck. [en.wikipedia.org]
A person with TTH may feel: as if they have a tight band around their head a constant, dull ache on both sides of the head pain spreading to or from the neck Tension-type headaches may be episodic or chronic. [medicalnewstoday.com]
Neurologic
- Encephalopathy
Hypertensive encephalopathy with reversible posterior leukoencephalopathy can present as a thunderclap headache. [ncbi.nlm.nih.gov]
PubMed View Article Google Scholar Tang-Wai DF, Phan TG, Wijdicks EF: Hypertensive encephalopathy presenting with thunderclap headache. Headache 2001, 41: 198–200. [doi.org]
Arch Gynecol Obstet 292(6):1217–1223 Article PubMed Google Scholar Roth C, Hügens-Penzel M, Ferbert A (2010) Posterior reversible encephalopathy syndrome (PRES). [thejournalofheadacheandpain.biomedcentral.com]
[…] as an infection hypothyroidism giant cell arteritis stroke brain tumor According to an article in Practical Neurology, secondary headaches that occur during pregnancy are often caused by underlying conditions like eclampsia and posterior reversible encephalopathy [medicalnewstoday.com]
- Exertional Headache
Cardiac cephalalgia should be considered one of the differential diagnoses of exertional headache and thunderclap headache when the patient is older or has cardiovascular risk factors. [ncbi.nlm.nih.gov]
Exertional Headaches : Like our weightlifter, people can develop a severe headache during or after physical exercise. Exertional headaches occur with physical exercise and usually resolve in a short period of time. [huffpost.com]
[…] or hemorrhage of the pituitary gland ) Colloid cyst of the third ventricle Meningitis, sinusitis Reversible cerebral vasoconstriction syndrome (previously Call-Fleming syndrome, several subtypes) Primary cough headache, primary exertional headache, and [en.wikipedia.org]
Exertional headaches/sexual headaches Exertional headaches are headaches associated with physical activity. [patient.info]
Case Primary Exertional[ 43 – 45 ] 7 Exertion Cohort Primary Exertional Headache[ 27 ] 17 Exertion Case Swimming headache followed by exertional and coital headache[ 46 ] 2 Exertion Case Primary Thunderclap Headache[ 47 – 49 ]* 13 Idiopathic Cohort Primary [doi.org]
- 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]
- Forgetful
[…] a J...Segura T 2013 48 Thunderclap headache: diagnostic considerations and neuroimaging features. ( 23245274 ) Mortimer AM...Renowden SA 2013 49 Thunderclap headache. ( 23303883 ) Ducros A...Bousser MG 2013 50 Don't forget phaeochromocytoma in the differential [malacards.org]
- 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]
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]
Cerebrospinal Fluid
- Xanthochromia
What are the Hurdles in Confirming Cerebrospinal Fluid Xanthochromia? CSF xanthochromia can be confirmed in two ways – (a) by visual inspection and (b) by spectrophotometry. [ncbi.nlm.nih.gov]
Results of computerized tomography (CT) scans of the head were normal, but on examination of the cerebrospinal fluid xanthochromia was found. Magnetic resonance (MR) imaging of the cervical spine revealed a retroclival hematoma. [thejns.org]
If this is normal, a lumbar puncture is performed, as a small proportion of SAH is missed on CT and can still be detected as xanthochromia. [1] [2] If both investigations are normal, the specific description of the headache and the presence of other abnormalities [en.wikipedia.org]
Other Pathologies
- Cerebral Angiitis
[…] communicating artery[ 118 ] 1 Inflammatory Arteriopathy (N = 6) Case Cerebral Angiitis[ 119, 120 ] 3 Case *Vogt-Koyanagi-Harada Disease[ 121, 122 ] 2 Case Subarachnoid Haemorrhage secondary to Inflammatory Vasculitis[ 123 ] 1 Cerebral Venous Sinus Thrombosis [doi.org]
Arch Neurol 52(11):1101 Article CAS PubMed Google Scholar Bakhru A, Atlas RO (2010) A case of postpartum cerebral angiitis and review of the literature. [thejournalofheadacheandpain.biomedcentral.com]
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]
TTH would be expected to improve during gestation as female hormones modulate serotonin and endorphins, which are involved in TTH pathophysiology [4]. [thejournalofheadacheandpain.biomedcentral.com]
Prevention
Can thunderclap headaches be prevented? Because they come on without warning, it’s difficult to prevent thunderclap headaches. Managing underlying health conditions and avoiding triggers are the best ways to keep them from occurring. [my.clevelandclinic.org]
Certain care strategies can help prevent headaches or ease the pain. [medicalnewstoday.com]
This may involve taking medication only when you get the headaches, taking daily medication to prevent them or, sometimes, stopping medication you are already taking. [patient.info]
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]
His report was headed `Ways of Preventing Industrial Accidents'. 5. (in football) to hit the ball with the head. He headed the ball into the goal. -headed having (a certain number or type of) head(s). a two-headed monster; a bald-headed man. [thefreedictionary.com]