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Thunderclap headache
	Classification and external resources
ICD-10	G44.80
ICD-9	339.43

A thunderclap headache is a headache that is severe and sudden (like a thunderclap).^[1] Because it may be a sign of a medical emergency, some sources recommend immediate medical attention.^[1]

In 25% of cases, a thunderclap headache is an indication of aneurysmal subarachnoid hemorrhage (SAH), which often leads to death or severe disability.^[2] Headaches which accompany SAH are "frequently described as being the worst headache of one's life, although other clinical presentations are possible."^[3]

Diagnosis is made via a process of exclusion with accompanying negative computed tomograph and lumbar puncture results.

[edit] Causes

Thunderclap headaches can be caused by a number of different primary conditions including^[4]^[5]

Subarachnoid hemorrhage
Cerebral venous thrombosis
Cervical artery dissection
Pituitary apoplexy
Ischemic stroke
Orgasm
Acute hypertensive crisis
Colloid cyst of the third ventricle
Meningitis
Reversible cerebral vasoconstriction syndromes or RCVS (this includes hypertensive encephalopathy and vasculopathies associated with pregnancy and postpartum (postpartum angiopathy))
Primary thunderclap headache
Complicated sinusitis^[6]

[edit] References

^ ^a ^b "Thunderclap headaches". Mayo Clinic. http://www.mayoclinic.com/print/thunderclap-headaches/DS00644/DSECTION=all&METHOD=print. Retrieved 2006-11-27.
^ Linn, F H H; G J E Rinkel, A Algra, J van Gijn (November 1998). "Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache". Journal of Neurology, Neurosurgery and Psychiatry 65: 791–793. doi:10.1136/jnnp.65.5.791. http://jnnp.bmj.com/cgi/content/full/65/5/791. Retrieved 2007-01-09.
^ "Evidence-Based Diagnosis of Nontraumatic Headache in the ER". Medscape. http://www.medscape.com/viewarticle/481270_3. Retrieved 2006-11-27.
^ Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW (October 2008). "Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache". Ann Emerg Med 52 (4): 407–36. doi:10.1016/j.annemergmed.2008.07.001. PMID 18809105.
^ "UpToDate Inc.". http://www.uptodate.com/online/content/topic.do?topicKey=headache/3013&selectedTitle=1~22&source=search_result#7.
^ http://www3.interscience.wiley.com/journal/118608409/abstract?CRETRY=1&SRETRY=0

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[Mayo-0] "Thunderclap headaches". Mayo Clinic. http://www.mayoclinic.com/print/thunderclap-headaches/DS00644/DSECTION=all&METHOD=print. Retrieved 2006-11-27.

[Linn-1] Linn, F H H; G J E Rinkel, A Algra, J van Gijn (November 1998). "Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache". Journal of Neurology, Neurosurgery and Psychiatry 65: 791–793. doi:10.1136/jnnp.65.5.791. http://jnnp.bmj.com/cgi/content/full/65/5/791. Retrieved 2007-01-09.

[Medscape-2] "Evidence-Based Diagnosis of Nontraumatic Headache in the ER". Medscape. http://www.medscape.com/viewarticle/481270_3. Retrieved 2006-11-27.

[ACEP2008-3] Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW (October 2008). "Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache". Ann Emerg Med 52 (4): 407–36. doi:10.1016/j.annemergmed.2008.07.001. PMID 18809105.

[4] "UpToDate Inc.". http://www.uptodate.com/online/content/topic.do?topicKey=headache/3013&selectedTitle=1~22&source=search_result#7.

[5] ttp://www3.interscience.wiley.com/journal/118608409/abstract?CRETRY=1&SRETRY=0

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