Thunderclap Headaches

What is a thunderclap headache?

A thunderclap headache is an extremely painful headache that comes on suddenly, like a clap of thunder. This type of headache has the most intense pain at its onset. People who have had a thunderclap headache often describe it as the worst headache of their life, unlike any headache they’ve ever experienced.

Thunderclap headaches strike without any warning. Sometimes there’s no underlying medical cause to them, but other times they’re a sign of very serious underlying conditions that involve bleeding in and around your brain.

This type of headache is rare. They occur in less than 50 out of 100,000 adults each year.

It’s important to seek medical attention immediately to rule out life-threatening causes of a thunderclap headache.

What does a thunderclap headache feel like?

The main symptom of a thunderclap headache is sudden and severe pain in your head. This pain reaches its most intense point within 60 seconds and lasts at least five minutes. It then usually fades within the next few hours. Other symptoms may include:

• Numbness.
• Weakness.
• Speech problems.
• Nausea and/or vomiting.
• Seizures.
• Change in vision.
• Confusion.

What’s the difference between a thunderclap headache and an ice pick headache?

Thunderclap headaches and ice pick headaches both come on suddenly, but they feel different.

An ice pick headache causes a sudden, sharp, stabbing head pain (or a quick series of pains). It typically only lasts a few seconds. People who have these headaches equate the pain to being stabbed in the head or eye with an ice pick. They typically occur in clusters with multiple repeated episodes.

Thunderclap headaches last longer than ice pick headaches, and they usually don’t feature multiple bursts of pain like ice pick headaches do.

People who experience migraine headaches and cluster headaches are more prone to ice pick headaches, and they’re generally not caused by a serious, acute medical condition. Thunderclap headaches, on the other hand, can be a sign of a serious health issue that requires immediate medical attention.

Can thunderclap headaches be harmless?

In some cases, a thunderclap headache can be harmless and not have an underlying medical cause. However, since there’s no way to know for sure why you’re experiencing a thunderclap headache, you should go to the emergency room if you’re experiencing one. They can be a sign of a serious medical condition affecting your brain.

A healthcare provider can order tests to determine what, if anything, is causing it.

What are the most common causes of a thunderclap headache?

All types of headaches have primary and secondary causes:

• Primary headache: People with a primary thunderclap headache experience head pain without other symptoms. There isn’t an underlying condition causing the pain. A primary thunderclap headache can be caused by cough, heavy exercise or exertion or sexual activity. Primary thunderclap headaches aren’t dangerous.
• Secondary headache: In a secondary thunderclap headache, a health condition, such as blood vessel issues in your brain (for example, a brain aneurysm), causes it along with other symptoms. A secondary thunderclap headache is a sign of a potentially life-threatening condition.

Since it’s impossible to know for certain if you’re having a primary or secondary thunderclap headache, it’s important to seek immediate medical attention if you experience one. Causes of secondary thunderclap headaches include:

• Subarachnoid hemorrhage (bleeding in the space that surrounds your brain). This is the most common cause.
• Reversible cerebral vasoconstriction syndrome (sudden constriction of the vessels that supply blood to your brain). This is the second most common cause.
• Brain aneurysm (bulging or bleeding blood vessel).
• Head injury that causes a brain bleed.
• Stroke (blocked or bleeding blood vessel).
• Sudden, severe rise in blood pressure.
• Late-term pregnancy complications including rise in blood pressure (eclampsia) and bleeding in your pituitary gland during pregnancy or soon after delivery.
• Pheochromocytoma and carcinoid tumors.
• Pituitary apoplexy (a blockage in blood flow or bleeding in your pituitary gland).

How are thunderclap headaches treated?

Thunderclap headaches are a medical emergency, and it’s important to assess them for an underlying cause. If healthcare providers find the cause, they tailor the treatment to address it. Some thunderclap headaches require surgery to repair torn or ruptured blood vessels. Your provider will determine the best treatment option based on the cause of the headache.

If a thunderclap headache isn’t associated with an urgent underlying condition (a primary thunderclap headache), your healthcare provider may treat it with medication. A nonsteroidal anti-inflammatory (NSAID) medicine can help reduce swelling.

Can thunderclap headaches be prevented?

Because they come on without warning, it’s difficult to prevent thunderclap headaches. Managing underlying health conditions and avoiding triggers are the best ways to keep them from occurring. If you have high blood pressure or vascular problems, it’s important to work with your healthcare provider to follow a regular treatment plan.

Maintaining a healthy diet and active lifestyle helps keep blood pressure from rising to levels that could cause a condition involving a thunderclap headache. In addition, quitting smoking and controlling cholesterol levels can help reduce the risk of blood vessel problems.

For some people, activities such as heavy exertion and sexual activity can trigger thunderclap headaches. Once you identify these triggers, avoiding them can help reduce the number of headaches you experience. Your healthcare provider can recommend treatment options, including medications, to reduce your likelihood of repeated thunderclap headaches.

When should I call the doctor or seek emergency care?

Go to the emergency room if you’re experiencing a thunderclap headache for the first time. It’s urgent to determine if a dangerous condition is the underlying cause so it can be treated quickly if necessary. Some conditions associated with a thunderclap headache can be fatal without prompt treatment.

What questions should I ask my doctor?

Some questions you may want to ask your doctor about thunderclap headaches include:

• What is causing my headache?
• What are my options for treatment?
• How long will it take for treatment to work?
• What are the risks and side effects of treatment?
• How can I prevent future thunderclap headaches?

When can I go back to my regular activities?

If a thunderclap headache isn’t caused by a serious underlying condition, people typically resume their usual activity as soon as the headache passes. The lengths of these headaches vary, but medications often provide relief within hours. Recovery times vary for people when an underlying condition causes a thunderclap headache. People who need brain surgery may require several weeks or even months of recovery before they return to normal activities.

A note from Cleveland Clinic

Everyone gets headaches from time to time for various reasons. But thunderclap headaches are no ordinary headaches. If you experience sudden, severe pain in your head — the worst headache you’ve ever had — go to the emergency room. A healthcare provider will order tests to determine if a more serious medical condition is causing it.