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Thunderclap headaches (worst headache ever) symptoms and diagnosis

Posted by mandyf on March 22, 2012

Thunderclap headaches are often known by the term patients reporting to the emergency room refer to them by – worst headache ever. A thunderclap clap headache by wither term lives up to its name as it is a sever and overwhelming assault that strikes fast and peaks in intensity within 60 seconds and may last for anywhere from an hour to week. When a patient presents with the description of a headache as “the worst headache ever” and provides a description within the basic range of the above mentioned parameters it is cause for concern.

Thunderclap headaches fall somewhere between uncommon and rare, and are often a warning sign of a potentially life threatening condition. Singer Bret Michaels is an example of a public figure that has presented with thunderclap headaches. In his case the complications were on the extreme side which is bleeding in and around the brain – the only thing worse would be death.

The proper diagnosis of a thunderclap headache would be based upon the following presentation of symptoms:

* The headache strikes immediately and intensely –  a Thunderclap headache does not build gradually
* It will peak in intensity within approximately one minute
* It will last for anywhere from one hour to as long as ten days in a worst case scenario
* It can induce nausea or vomiting
* The pain can be localized to the head, or extend to the neck region – it is often described as feeling like a severe blow to the head

A thunderclap headache is by many doctors considered the most severe headache – even beyond a migraine. While not every thunderclap headache is life threatening, there are several conditions which can cause a thunderclap headache which are potentially fatal which include:

*A ruptured blood vessel in the brain
* A tear to the lining of an artery that supplies blood to the brain
* A tumor in the third ventricle of the brain that blocks cerebrospinal fluid
* Bleeding between the brain and the membranes that cover the brain
* A blood clot in the brain
* Severe elevation in blood pressure
* Death of tissue or bleeding in the pituitary gland
* Infection like encephalitis or meningitis

After presenting at the ER or your physician with symptoms indicative of thunderclap headaches, there are several tests that can be accomplished to seek a definitive diagnosis. Please keep in mind that due to the potentially sever consequences of a thunderclap headache, you should plan on undergoing one of these tests immediately. With that in mind plan ahead and whenever possible make sure that someone accompanies you.  One of the following tests will mot likely be accomplished:

*Spinal tap
* CT Scan
* Magnetic resonance angiography

It is also worth keeping in mind that these tests are performed because there is no treatment for a thunderclap headache. A thunderclap headache is in most cases a symptom of a greater problem, and as such the underlying cause that triggered the headache has to be discovered and treated. Successful treatment of that condition is what will end the headache assuming a cause can be found.

Johns Hopkins
Mayo Clinic


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