Thunderclap Headache

Excerpt

Day and Raskin are credited with coining the term thunderclap headache (TCH). The term was used in a case report published in 1986 of a 42-year-old woman who presented with an intense, sudden-onset headache she described as "like a hammer hitting my head." They concluded, "Hemorrhage into the wall of an aneurysm is a possible cause of thunderclap headache attacks before rupture."

Primary TCH is an "other primary headache disorder" in the third edition of the International Classification of Headache Disorders (ICHD-3). TCH is defined as a high-intensity headache of abrupt onset, mimicking that of a ruptured cerebral aneurysm, in the absence of any intracranial pathology. However, according to the ICHD-3, "Evidence that thunderclap headache exists as a primary disorder is poor: the search for an underlying cause should be both expedited and exhaustive."

What differentiates thunderclap headaches from other headache types is how rapidly they reach their peak intensity, not the headache intensity itself. TCH is often associated with a potentially fatal etiology, such as subarachnoid hemorrhage (SAH), and is considered a medical emergency.