Sunday, November 29, 2020


 Q: One of the most common cause of Thunderclap Headache (TCH) is subarachnoid hemorrhage (SAH)?

A) True

B) False

Answer: A

The two most common causes of TCH are subarachnoid hemorrhage (SAH) and reversible cerebral vasoconstriction syndromes (RCVS). Other less common causes include but not limited to are meningitis, complicated sinusitis, cerebral venous thrombosis, cervical artery dissection, acute hypertensive crisis, posterior reversible leukoencephalopathy syndrome (PRES), intracerebral hemorrhage, and ischemic stroke.

Almost half of the patients with SAH have a presenting symptom of TCH. SAH is almost certain unless ruled out if it presents in association with impaired consciousness, neck stiffness, nausea, vomiting, exertion immediately preceding the onset of TCH, hypertension,  occipital headache, and history of smoking. Any TCH should be evaluated with concern.



1. Ducros A, Bousser MG. Thunderclap headache. BMJ 2013; 346:e8557. 

2.  Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38:1. 

3. Schwedt TJ. Thunderclap Headache. Continuum (Minneap Minn) 2015; 21:1058. 

4. Perry JJ, Stiell IG, Sivilotti ML, et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA 2013; 310:1248.

5. Linn FH, Rinkel GJ, Algra A, van Gijn J. Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache. J Neurol Neurosurg Psychiatry 1998; 65:791.

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