A thunderclap headache can drive you to your knees in a matter of seconds. This type of pain is of a sudden onset, and peaks within 60 seconds. The pain can be on either side of the head, back of the head or even all over.
The pain is disabling but may linger up to 10 days. What we worry about with thunderclap headaches is the cause behind them. This may truly be a dangerous headache or an emergency headache. What is also of concern is if you have never had this kind of pain before.
Causes of Thunderclap Headaches
At times a severe migraine may appear suddenly like a thunderclap headache. What may worry medical professionals is the potential underlying cause:
Bleeding between the brain and membranes covering the brain
A bulge in a blood vessel in the brain(aneurysm) which may start to leak or rupture
A tear in the lining of an artery known as dissection
A tear in the membrane surrounding the brain and spinal cord, causing a cerebrospinal fluid leak
A cyst blocking the flow of cerebrospinal fluid
Bleeding in the pituitary gland
o Infection, such as meningitis or encephalitis
Diagnosis and Testing
CT of brain. This is probably ordered emergently to rule out a bleed of any sort, or a cyst in the brain. CT's are a form of X-ray radiation whereas an MRI uses magnets and the differences between water and tissue to visualize the brain. This gives much sharper images than a CT. Angiogram: If your doctor suspects an aneurysm, an angiogram may be ordered. This is an injection of dye to get a very close look at the arteries.
Treatment
Treatment of this type of headache is directed at the underlying cause, so there is no one treatment that fits all so to speak.
Aneurysms are generally watched and followed with regular imaging studies if they are 5mm or less. Anything over that requires the opinion of a neurosurgeon as to whether or not they should have an operation. Treatment for this involves clipping the aneurysm or coiling inside it. Strokes or bleeding are managed depending on the site and length of time from the bleed. Meningitis or encephalitis would require an in hospital stay with proper monitoring and medications.
Remember, a thunderclap headache can be a dangerous emergency headache, so see a doctor soon if this happens to you.
HeadacheMary K. Betz, MS RPA-C is a practicing Physician Assistant in neurology who specializes in headache medicine at a large headache center. Take charge of your headaches by learning more at http://www.headache-adviser.com