This may be analogous to a primary thunderclap headache—a headache disorder that causes a sudden, extraordinarily severe and explosive onset of head pain.
It’s important to note that this headache can mimic the same type of pain that accompanies life-threatening brain disorders—so, if a person has a thunderclap headache, they need to seek emergency medical attention.
In fact, a thunderclap headache is actually more likely to be from a serious blood vessel problem in the brain (like a subarachnoid hemorrhage) or another organic brain problem, than this rare primary headache disorder.
Overview
The International Headache Society defines a primary thunderclap headache as a “high-intensity headache of abrupt onset mimicking that of a ruptured cerebral aneurysm, in the absence of any intracranial pathology."
Also, according to the IHS “evidence that thunderclap headache exists as a primary disorder is rare.” This means that an extremely thorough workup needs to be done on a person with a thunderclap headache to make sure nothing more serious is going on.
In other words, primary thunderclap headache is a diagnosis of exclusion—everything else must be ruled out first.
Symptoms
According to the classification criteria of the third edition of the International Classification of Headache Disorder, symptoms of a primary thunderclap headache include:
Intensity: Severe, “worst headache of my life. “Onset: Sudden, reaching maximum intensity in < 1 minuteDuration: Lasts 5 or more minutes.
In addition to the above features, a primary thunderclap headache cannot be explained by another medical condition.
Diagnosis
A thunderclap headache is an unusual cause of a primary headache and every means should be taken to rule out other more serious medical conditions. For instance, vascular or blood vessel disorders of the brain, like a subarachnoid hemorrhage, often cause a thunderclap headache—so it’s imperative these life-threatening conditions are ruled out first.
A person with a thunderclap headache must have a lumbar puncture showing normal cerebrospinal fluid or CSF, as well as normal brain imaging, usually with a brain CT scan and/or brain magnetic resonance imaging (MRI). Usually, a magnetic resonance angiography (MRA), and/or venography (MRV) is done to further rule out any blood vessel problem in the brain. Sometimes a cerebral angiogram is performed.
Examples of headaches that may mimic primary thunderclap headache are:
Subarachnoid hemorrhage Intracerebral hemorrhage Cerebral Venous Thrombosis Pituitary apoplexy Arterial dissection Infections like acute sinusitis or meningitis Ischemic stroke Acute hypertensive crisis Reversible cerebrovasoconstriction syndrome Spontaneous intracranial hypotension Colloid cyst of the third ventricle
Cause
The cause of a primary thunderclap headache is largely unknown. It may be related to a spasm of the blood vessels in the brain.
Treatment
Treatment of a thunderclap headache depends on the origin. For instance, the treatment of a subarachnoid hemorrhage would involve emergent medical and/or neurosurgical interventions.
If medical emergencies have been ruled out, treatment for a primary thunderclap headache can be challenging. Individuals generally do not respond well to typical headache pain relievers.
One older study in Neurology showed that nimodipine, a calcium channel blocker, may provide headache resolution in people with primary thunderclap headache. But, the study was quite small—only 11 patients—and there was no control group, which suggests a possible placebo effect.
More research on this rare primary headache disorder would be useful.
