Abrupt-Onset Severe Headaches

Semin Neurol 2010; 30(2): 192-200 DOI: 10.1055/s-0030-1249229

© Thieme Medical Publishers

Yo-El S. Ju1, Todd J. Schwedt1

1 Department of Neurology, Washington University School of Medicine, St. Louis, Missouri

ABSTRACT

Thunderclap headache, a severe headache which is maximal in intensity at onset, is associated with numerous underlying disorders, including

1. subarachnoid hemorrhage, 
2. unruptured intracranial aneurysm, 
3. cervical artery dissection, 
4. cerebral venous sinus thrombosis, 
5. stroke, 
6. intracranial hemorrhage, 
7. reversible cerebral vasoconstriction syndrome, and 
8. reversible posterior leukoencephalopathy. 

After exclusion of all possible causes, thunderclap headache may be considered a primary headache.

This review summarizes the diagnostic considerations and clinical approach to thunderclap headache, with particular emphasis on the reversible cerebral vasoconstriction syndromes.