Thunderclap Headache: Why Many Call it The “Worst Headache Ever”

A thunderclap headache strikes hard and fast, as the name suggests. While other headaches and migraines come and go without much trouble, this type of headache can be a medical emergency. Learn more about what a thunderclap headache is and why many call it the worst headache of their life.

How headaches occur

There are two broad categories of headaches: primary and secondary headaches. Primary headaches are further divided into characteristics such as tension-type, migraine, stabbing, cluster, and so on.

On the other hand, secondary headaches are headaches triggered by a separate disease or illness. Infections, head trauma, and brain tumors can all cause secondary headaches.

While the brain itself does not contain pain receptors, it is responsible for receiving all pain-related signals from other parts of the body and the meninges. The meninges are layers of membranes that cover and protect the brain. It is extremely sensitive to changes in pressure and irritating substances.

Headaches occur when the vessels or meninges surrounding the brain are stretched or damaged. In addition, muscles around the neck and skull can also induce headaches. Dehydration, meningitis, and brain tumors can all trigger secondary headaches as they progress. Certain medications and even low blood sugar may also trigger a headache.

What makes a thunderclap headache different?

While each headache has its own characteristics, they tend to be tolerable and predictable. For example, if you feel your forehead muscles tensing you may expect a tension headache approaching. While many migraine sufferers experience an aura before the pain hits.

However, a thunderclap headache happens without warning and peaks within a minute. It is usually a type of secondary headache, so the underlying cause should be investigated immediately.

Depending on other symptoms, the causes can include the following conditions:

• Ruptured brain aneurysm
• Hemorrhagic stroke
• Blood clot
• Meningitis

If no underlying disease can be identified, the thunderclap headache is primary or idiopathic (unknown etiology or cause). 

In younger adults who experience this type of headache, they may have reversible cerebral vasoconstriction syndrome (RCVS). Brain imaging studies will show a “sausage on a string” pattern of several blood vessels. RCVS can trigger multiple thunderclap headaches in a few days’ time and increase the risk of developing brain hemorrhage or stroke later in life.

Treatment options

Unfortunately, there are no specific medication or treatment options available for primary thunderclap headaches. When it comes to secondary-type thunderclap headaches, treat the underlying cause as soon as possible. Contact your doctor or go to the emergency room right away. Once resolved, the headache should be reduced or completely gone.

The worst pain settles a few minutes after the peak, but moderate to severe pain may still be felt for hours after. Bed rest, hydration, and OTC pain relievers can help. For severe pain, your doctor may prescribe stronger pain relievers such as opioids.

Additionally, it is best to avoid exacerbating substances and activities. Do not take medications that can constrict blood vessels, such as steroids, anti-migraine medications, and cold preparations. Avoid stress, heavy lifting, and vigorous exercise as these can trigger headaches and RCVS.

Key takeaways

In summary, a thunderclap headache is a serious condition. Those who experience it are not simply being sensitive or overreacting to the pain. It can be a sign of something much worse, such as a ruptured brain aneurysm or meningitis. So, it is imperative to seek medical help as soon as possible to prevent further injury or death.