Thunderclap Headache

  • Esma Dilli
Headache (R Halker, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Headache


Thunderclap headache (TCH) is a sudden severe headache that peaks to maximum intensity within 1 minute. Subarachnoid hemorrhage is the most commonly identified etiology for this headache, however, other secondary etiologies should be considered. Sentinel headache, reversible cerebral vasoconstriction syndrome, arterial dissection, cerebral venous sinus thrombosis, pituitary apoplexy, intracranial hemorrhage, ischemic stroke, reversible posterior leukoencephalopathy, spontaneous intracranial hypotension, colloid cyst, and intracranial infections are other possible causes of TCH. Investigations for the etiology of TCH begin with noncontrast CT head and lumbar puncture. MR brain, CT angiogram, MR angiogram, or CT/MR venogram may need to be performed if the initial investigations are negative. Treatment and prognosis depend on the etiology of the TCH.


Thunderclap headache Subarachnoid hemorrhage Aneurysm ∙ Reversible cerebral vasoconstriction syndrome Reversible posterior leukoencephalopathy Sentinel headache Cerebral venous sinus thrombosis Arterial dissection Pituitary apoplexy Spontaneous intracranial hypotension Colloid cyst 


Compliance with Ethics Guidelines

Conflict of Interest

Esma Dilli has received honoraria from Merck, UCB, Johnson and Johnson, Allergan, and Tribute Pharmaceuticals. Further, she has received payments for development of educational presentations from Medical Education Speakers Network and Allergan. She also has received paid travel/accommodations expenses from the Canadian Headache Society for a Headache Course for Canadian neurology residents.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Esma Dilli
    • 1
  1. 1.Department of Medicine, Division of NeurologyUniversity of British ColumbiaVancouverCanada

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