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Clinical presentation

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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:

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