clinical presentation

Last reviewed 01/2018

Patients with a first presentation of thunderclap headache should be referred immediately to hospital for same day specialist assessment (1).

A detailed history should be obtained to recognize thunderclap headache.

• the rapidity with which the TCH reached it's peak and what the maximum severity was on an 11 pointscale  - 0 no pain; 1-3 mild pain; 4-6 moderate pain; 7-9 severe pain; 10 worst pain ever
• a headache that reaches 7 or more within less than one minute is considered to be a thunderclap headache
  
  
•  the pain maybe localized to 1 region or maybe holocephalic
  
  
• TCH maybe accompanied by several other symptoms which may indicate the underlying cause
• neck stiffness: subarachnoid haemorrhage or meningitis
• transient loss of consciousness: subarachnoid haemorrhage (around 50% of cases), colloid cyst of the third ventricle
• epileptic seizure: subarachnoidhaemorrhage,other stroke, cerebral venous thrombosis, posteriorreversibleencephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS)
• focal neurological symptoms: subarachnoid haemorrhage, other stroke, cerebral venous thrombosis
• papilloedema: intracranial hypertension

Reference:

• (1) SIGN (March 2008).Diagnosis and Management of headaches in adult.
• (2) Ducros A, Bousser MG. Thunderclap headache. BMJ. 2013;346:e8557