secondary causes of thunderclap headache

Last reviewed 06/2023

secondary causes of thunderclap headaches

An underlying cause should be considered in any patient with thunderclap headache even with a history of recurrent headaches (such as migraine).

• subarachnoid hemorrhage
• most common cause
• around 50% of patients presents with thunderclap pattern of headache
• subarachnoid haemorrhage is found in 11-25% of 50%.8-11 Subarachnoid haemorrhage is found in 11-25% of patients who present with thunderclap headache (1)
  
  
• sentinel headache
• reversible cerebral vasoconstriction syndrome
• cerebral venous sinus thrombosis
• cervical artery dissection
• spontaneous intracranial hypotension
• acute hypertensive crisis
• intracerebral haemorrhage
• pituitary apoplexy
• brain infarct
• hydrocephalus (aqueductal stenosis, Chiari type 1 malformation)
• tumour (third ventricle colloid cyst, posterior fossa tumour)
• ischemic stroke
• primary cough, sexual, and exertional headache
• myocardial infarction
• pheochromocytoma

Reference:

• (1) Ducros A, Bousser MG. Thunderclap headache. BMJ. 2013;346:e8557  
• (2) Tarshish S, Robbins MS. Teaching case presentation--primary thunderclap headache. Headache. 2009;49(8):1249-50