Table of ContentsView AllTable of ContentsSymptomsCausesTreatmentComplicationsDiagnosisWhen to See a Provider
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Treatment
Complications
Diagnosis
When to See a Provider
Thunderclap Headache Is a Medical EmergencyIf you are experiencing a thunderclap headache, call 911 immediately.
Thunderclap Headache Is a Medical Emergency
If you are experiencing a thunderclap headache, call 911 immediately.
A thunderclap headache strikes suddenly, causing severe, explosive head pain that rapidly peaks in intensity within one minute and lasts at least five minutes.While not common, thunderclap headaches are warning signs of potentially fatal conditions, like bleeding within or around the brain.
This article will review the symptoms, causes, diagnosis, and treatment of a thunderclap headache. It will also explain why a thunderclap headache is a medical emergency that’s almost always considered dangerous.
The Good Brigade / Getty Images
Symptoms of Thunderclap Headache
Individuals with a thunderclap headache often describe it as the worst headache they have ever experienced. The headache is excruciatingly painful and begins abruptly and unexpectedly, like a clap of thunder.
Such symptoms may include:
Causes of Thunderclap Headache
Thunderclap headache is classified as either a primary or secondary headache.
Primary Thunderclap Headache
Diagnosis of ExclusionDiagnosis of a primary thunderclap is one of exclusion. This means an exhaustive approach to rule out secondary causes must be performed first.
Diagnosis of Exclusion
Diagnosis of a primary thunderclap is one of exclusion. This means an exhaustive approach to rule out secondary causes must be performed first.
Secondary Thunderclap Headache
An underlying health factor within the brain causes secondary thunderclap headaches, such as a blood vessel problem, an unusual structural abnormality, trauma, or an infection.
The most common secondary cause of a thunderclap headache issubarachnoid hemorrhage.Subarachnoid hemorrhage is a dangerous, potentially life-threateningbrain bleedin which blood pools in the space between the brain and the tissue layer covering it.
Another common cause of a thunderclap headache isreversible cerebral vasoconstriction syndrome(RCVS). With RCVS, the blood vessels in the brain suddenly tighten, and a person experiences multiple thunderclap headaches over a few days to weeks.
Less common but still serious causes of a thunderclap headache include:
Uncommon or rare secondary causes of a thunderclap headache include:
How to Treat a Thunderclap Headache
The treatment of a thunderclap headache depends on whether it’s a primary or secondary headache.
A primary thunderclap headache is treated with anonsteroidal anti-inflammatory drug(NSAID), commonly Indocin (indomethacin).
The treatment of a secondary thunderclap headache involves addressing the underlying cause.
For example, individuals withsubarachnoid hemorrhageare treated in a hospital’sintensive care unit(ICU).
In the ICU, medications are given to control blood pressure and seizure activity. Blood-thinning medicines like aspirin and Jantoven (warfarin) are also discontinued to help stop bleeding.
A surgical procedure prevents rebleeding if a ruptured aneurysm causes a subarachnoid hemorrhage.
Surgery for Ruptured AneurysmOne of the following surgeries is performed for a ruptured aneurysm:Surgical clipping: Aneurosurgeon(a doctor who performs surgery on the brain and spinal cord) removes a part of the skull and places a small clip on the neck of the aneurysm to stop its blood supply.Endovascular coiling: Aninterventional neuroradiologist(a doctor who uses imaging/catheter-based techniques) places a catheter into the groin artery, threading it through the body to the brain. Small thin metal coils are passed through the catheter and released into the aneurysm to stop blood flow.
Surgery for Ruptured Aneurysm
One of the following surgeries is performed for a ruptured aneurysm:Surgical clipping: Aneurosurgeon(a doctor who performs surgery on the brain and spinal cord) removes a part of the skull and places a small clip on the neck of the aneurysm to stop its blood supply.Endovascular coiling: Aninterventional neuroradiologist(a doctor who uses imaging/catheter-based techniques) places a catheter into the groin artery, threading it through the body to the brain. Small thin metal coils are passed through the catheter and released into the aneurysm to stop blood flow.
One of the following surgeries is performed for a ruptured aneurysm:
Examples of treatments for other conditions include:
Complications Associated With a Thunderclap Headache
Various complications may arise depending on the underlying cause of a thunderclap headache.
For instance, people with asubarachnoid hemorrhagetypically stay in the intensive care unit (ICU) for several days or weeks to stabilize and be monitored for complications.
Possible complications of a subarachnoid hemorrhage include:
Examples of possible complications for other conditions include:
Are There Tests to Diagnose the Cause of a Thunderclap Headache?
Diagnosing the cause of a thunderclap headache requires prompt medical action.
The first test is almost always acomputed tomography (CT) scanof the brain to check for subarachnoid hemorrhage, the most common and catastrophic cause.
What Is a CT Scan?A CT scan is an imaging test that uses X-rays and a computer to create pictures of the inside of the body.
What Is a CT Scan?
A CT scan is an imaging test that uses X-rays and a computer to create pictures of the inside of the body.
If the CT scan is negative for bleeding around the brain, alumbar puncture(spinal tap) is performed. Excess red blood cells in the cerebrospinal fluid support a diagnosis of subarachnoid hemorrhage.
Other diagnostic tests used to investigate a thunderclap headache include:
What Is a Headache?
When to See a Healthcare Provider
A thunderclap headache always warrants emergency medical investigation. Call 911 if your headache is severe, begins suddenly, and/or feels like the “worst headache of your life.”
Summary
A thunderclap headache is a sudden, explosive headache that reaches its maximum pain intensity within one minute. Most thunderclap headaches are secondary headaches with an attributable cause, like bleeding or a blood vessel problem within the brain.
CT scans, a spinal tap, and other imaging tests are used to diagnose the underlying cause of most thunderclap headaches. Treatment involves addressing the root cause, often including intensive care, intravenous medications, or surgery.
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dilli E.Thunderclap headache.Curr Neurol Neurosci Rep. 2014;14(4):437. doi:10.1007/s11910-014-0437-9Aladakatti R, Sannakki LB, Cai PY, Derequito R.Thunderclap headache: It is always sub-arachnoid hemorrhage. Is it? - A case report and review.Surg Neurol Int. 2014;5:22. doi:10.4103/2152-7806.127756International Headache Society.Primary thunderclap headache.Chen CY, Fuh JL.Evaluating thunderclap headache.Curr Opin Neurol. 2021;34(3):356-362. doi:10.1097/WCO.0000000000000917Ducros A, Wolff V.The typical thunderclap headache of reversible cerebral vasoconstriction syndrome and its various triggers.Headache. 2016;56(4):657-73. doi:10.1111/head.12797Yang C-W, Fuh J-L.Thunderclap headache: an update.Expert Rev Neurother.2018;18(12):915-924. doi:10.1080/14737175.2018.1537782Devenney E, Neale H, Forbes RB.A systematic review of causes of sudden and severe headache (thunderclap headache): should lists be evidence based?J Headache Pain. 2014;15(1):49. doi:10.1186/1129-2377-15-49Bahra A.Other primary headaches-thunderclap-, cough-, exertional-, and sexual headache.J Neurol. 2020 May;267(5):1554-1566. doi:10.1007/s00415-020-09728-0Yao Z, Hu X, Ma L, You C, He M.Timing of surgery for aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis.Int J Surg. 2017 Dec;48:266-274. doi:10.1016/j.ijsu.2017.11.033Fonarow GC, Zhao X, Smith EE, et al.Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative.JAMA. 2014;311(16):1632-1640. doi:10.1001/jama.2014.3203Danière F, Gascou G, Menjot de Champfleur N, et al.Complications and follow up of subarachnoid hemorrhages.Diagn Interv Imaging. 2015;96(7-8):677-686. doi:10.1016/j.diii.2015.05.006Breville G, Bailly A, Fisch L, Kulcsar Z, Pugin D, Carrera E.Case report and review of the literature: fatal reversible cerebral vasoconstriction syndrome.Front Neurol.2021;12:589062. doi:10.3389/fneur.2021.589062John S, Singhal AB, Calabrese L, et al.Long-term outcomes after reversible cerebral vasoconstriction syndrome.Cephalalgia. 2016;36(4):387-394. doi:10.1177/0333102415591507Medeiros GC, Roy D, Kontos N, Beach SR.Post-stroke depression: A 2020 updated review.Gen Hosp Psychiatry. 2020;66:70-80. doi:10.1016/j.genhosppsych.2020.06.011
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dilli E.Thunderclap headache.Curr Neurol Neurosci Rep. 2014;14(4):437. doi:10.1007/s11910-014-0437-9Aladakatti R, Sannakki LB, Cai PY, Derequito R.Thunderclap headache: It is always sub-arachnoid hemorrhage. Is it? - A case report and review.Surg Neurol Int. 2014;5:22. doi:10.4103/2152-7806.127756International Headache Society.Primary thunderclap headache.Chen CY, Fuh JL.Evaluating thunderclap headache.Curr Opin Neurol. 2021;34(3):356-362. doi:10.1097/WCO.0000000000000917Ducros A, Wolff V.The typical thunderclap headache of reversible cerebral vasoconstriction syndrome and its various triggers.Headache. 2016;56(4):657-73. doi:10.1111/head.12797Yang C-W, Fuh J-L.Thunderclap headache: an update.Expert Rev Neurother.2018;18(12):915-924. doi:10.1080/14737175.2018.1537782Devenney E, Neale H, Forbes RB.A systematic review of causes of sudden and severe headache (thunderclap headache): should lists be evidence based?J Headache Pain. 2014;15(1):49. doi:10.1186/1129-2377-15-49Bahra A.Other primary headaches-thunderclap-, cough-, exertional-, and sexual headache.J Neurol. 2020 May;267(5):1554-1566. doi:10.1007/s00415-020-09728-0Yao Z, Hu X, Ma L, You C, He M.Timing of surgery for aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis.Int J Surg. 2017 Dec;48:266-274. doi:10.1016/j.ijsu.2017.11.033Fonarow GC, Zhao X, Smith EE, et al.Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative.JAMA. 2014;311(16):1632-1640. doi:10.1001/jama.2014.3203Danière F, Gascou G, Menjot de Champfleur N, et al.Complications and follow up of subarachnoid hemorrhages.Diagn Interv Imaging. 2015;96(7-8):677-686. doi:10.1016/j.diii.2015.05.006Breville G, Bailly A, Fisch L, Kulcsar Z, Pugin D, Carrera E.Case report and review of the literature: fatal reversible cerebral vasoconstriction syndrome.Front Neurol.2021;12:589062. doi:10.3389/fneur.2021.589062John S, Singhal AB, Calabrese L, et al.Long-term outcomes after reversible cerebral vasoconstriction syndrome.Cephalalgia. 2016;36(4):387-394. doi:10.1177/0333102415591507Medeiros GC, Roy D, Kontos N, Beach SR.Post-stroke depression: A 2020 updated review.Gen Hosp Psychiatry. 2020;66:70-80. doi:10.1016/j.genhosppsych.2020.06.011
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Dilli E.Thunderclap headache.Curr Neurol Neurosci Rep. 2014;14(4):437. doi:10.1007/s11910-014-0437-9Aladakatti R, Sannakki LB, Cai PY, Derequito R.Thunderclap headache: It is always sub-arachnoid hemorrhage. Is it? - A case report and review.Surg Neurol Int. 2014;5:22. doi:10.4103/2152-7806.127756International Headache Society.Primary thunderclap headache.Chen CY, Fuh JL.Evaluating thunderclap headache.Curr Opin Neurol. 2021;34(3):356-362. doi:10.1097/WCO.0000000000000917Ducros A, Wolff V.The typical thunderclap headache of reversible cerebral vasoconstriction syndrome and its various triggers.Headache. 2016;56(4):657-73. doi:10.1111/head.12797Yang C-W, Fuh J-L.Thunderclap headache: an update.Expert Rev Neurother.2018;18(12):915-924. doi:10.1080/14737175.2018.1537782Devenney E, Neale H, Forbes RB.A systematic review of causes of sudden and severe headache (thunderclap headache): should lists be evidence based?J Headache Pain. 2014;15(1):49. doi:10.1186/1129-2377-15-49Bahra A.Other primary headaches-thunderclap-, cough-, exertional-, and sexual headache.J Neurol. 2020 May;267(5):1554-1566. doi:10.1007/s00415-020-09728-0Yao Z, Hu X, Ma L, You C, He M.Timing of surgery for aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis.Int J Surg. 2017 Dec;48:266-274. doi:10.1016/j.ijsu.2017.11.033Fonarow GC, Zhao X, Smith EE, et al.Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative.JAMA. 2014;311(16):1632-1640. doi:10.1001/jama.2014.3203Danière F, Gascou G, Menjot de Champfleur N, et al.Complications and follow up of subarachnoid hemorrhages.Diagn Interv Imaging. 2015;96(7-8):677-686. doi:10.1016/j.diii.2015.05.006Breville G, Bailly A, Fisch L, Kulcsar Z, Pugin D, Carrera E.Case report and review of the literature: fatal reversible cerebral vasoconstriction syndrome.Front Neurol.2021;12:589062. doi:10.3389/fneur.2021.589062John S, Singhal AB, Calabrese L, et al.Long-term outcomes after reversible cerebral vasoconstriction syndrome.Cephalalgia. 2016;36(4):387-394. doi:10.1177/0333102415591507Medeiros GC, Roy D, Kontos N, Beach SR.Post-stroke depression: A 2020 updated review.Gen Hosp Psychiatry. 2020;66:70-80. doi:10.1016/j.genhosppsych.2020.06.011
Dilli E.Thunderclap headache.Curr Neurol Neurosci Rep. 2014;14(4):437. doi:10.1007/s11910-014-0437-9
Aladakatti R, Sannakki LB, Cai PY, Derequito R.Thunderclap headache: It is always sub-arachnoid hemorrhage. Is it? - A case report and review.Surg Neurol Int. 2014;5:22. doi:10.4103/2152-7806.127756
International Headache Society.Primary thunderclap headache.
Chen CY, Fuh JL.Evaluating thunderclap headache.Curr Opin Neurol. 2021;34(3):356-362. doi:10.1097/WCO.0000000000000917
Ducros A, Wolff V.The typical thunderclap headache of reversible cerebral vasoconstriction syndrome and its various triggers.Headache. 2016;56(4):657-73. doi:10.1111/head.12797
Yang C-W, Fuh J-L.Thunderclap headache: an update.Expert Rev Neurother.2018;18(12):915-924. doi:10.1080/14737175.2018.1537782
Devenney E, Neale H, Forbes RB.A systematic review of causes of sudden and severe headache (thunderclap headache): should lists be evidence based?J Headache Pain. 2014;15(1):49. doi:10.1186/1129-2377-15-49
Bahra A.Other primary headaches-thunderclap-, cough-, exertional-, and sexual headache.J Neurol. 2020 May;267(5):1554-1566. doi:10.1007/s00415-020-09728-0
Yao Z, Hu X, Ma L, You C, He M.Timing of surgery for aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis.Int J Surg. 2017 Dec;48:266-274. doi:10.1016/j.ijsu.2017.11.033
Fonarow GC, Zhao X, Smith EE, et al.Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative.JAMA. 2014;311(16):1632-1640. doi:10.1001/jama.2014.3203
Danière F, Gascou G, Menjot de Champfleur N, et al.Complications and follow up of subarachnoid hemorrhages.Diagn Interv Imaging. 2015;96(7-8):677-686. doi:10.1016/j.diii.2015.05.006
Breville G, Bailly A, Fisch L, Kulcsar Z, Pugin D, Carrera E.Case report and review of the literature: fatal reversible cerebral vasoconstriction syndrome.Front Neurol.2021;12:589062. doi:10.3389/fneur.2021.589062
John S, Singhal AB, Calabrese L, et al.Long-term outcomes after reversible cerebral vasoconstriction syndrome.Cephalalgia. 2016;36(4):387-394. doi:10.1177/0333102415591507
Medeiros GC, Roy D, Kontos N, Beach SR.Post-stroke depression: A 2020 updated review.Gen Hosp Psychiatry. 2020;66:70-80. doi:10.1016/j.genhosppsych.2020.06.011
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
