A headache can happen unexpectedly and be very painful. But if the pain comes on suddenly, reaches its peak within a minute, and is accompanied by nausea or vomiting, it needs urgent medical attention, becoming an emergency. This is known as a thunderclap headache.
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Dr Vipul Gupta, director of neurointerventional surgery at Sir H.N. Reliance Foundation Hospital, Mumbai, explained what causes it, how it differs from a migraine, and why it should never be ignored.
The surgeon elaborated on what sets a thunderclap headache apart: how quickly the pain reaches its peak and how patients describe the headache.
“Thunderclap headaches are sudden and very severe headaches that typically peak within 60 seconds. The extremely sudden onset and severity are the reasons why they are called as thunderclap headaches. Patients usually mention them as being the worst headache of their life, unlike any previous headache which they may have experienced,” he said.
How is a thunderclap headache different from a migraine?
A migraine can be intensely painful, so from the severity of the pain alone you may not be able to tell what is happening. Dr Gupta said the key difference is how quickly the headache reaches its peak.
“Although migraine headaches can be very severe, the patient will usually mention that the headache started gradually, taking much longer time to reach the peak of the severity. Also, patients with migraine usually would have experienced severe headaches in the past as well,” he said.
What is the red-flag symptom that indicates the onset of this thunderclap headache?
The main warning sign is a sudden, severe headache that reaches peak intensity within about a minute. Dr Gupta said it may also be accompanied by:
- Nausea or vomiting
- Seizures
- Numbness or weakness
- Confusion or other changes in mental state
It is essential to identify early, as a thunderclap headache can signal a life-threatening condition in the brain. Immediately go see a doctor if one occurs, even without these additional symptoms.
What happens if you ignore a thunderclap headache?
A thunderclap headache can be a warning sign of bleeding around the brain. Dr Gupta identified subarachnoid hemorrhage as one of its most dangerous possible causes.
“Subarachnoid hemorrhage is bleeding in the fluid space surrounding the brain, with the most common reason being cerebral aneurysms. Cerebral aneurysms are swelling or ballooning of the brain arteries which supply blood to the brain,” he said.
This is why someone with a thunderclap headache should be taken to hospital immediately for imaging. The pain alone cannot reveal whether bleeding has occurred. Dr Gupta said a CT scan is commonly used to detect bleeding in the brain, while angiographic tests, such as digital subtraction angiography or CT/MR angiography to diagnose brain aneurysms.
A sudden headache that reaches its worst intensity within a minute should never be dismissed as an unusually bad migraine. Even if the pain goes down, go check with doctor so they can check for bleeding or another serious cause.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
