Abstract

Thunderclap headache(TCH) is a hyperacute, severe headache that is so named because of its sudden onset. It often heralds a serious intracranial vascular event such as subarachnoid hemorrhage, cerebral venous sinus thrombosis or pituitary apoplexy. However, it may also occur spontaneously or in the setting of cerebral vasoconstriction. The term primary TCH is often used to refer to a benign, idiopathic, and potentially recurrent headache of sudden and severe intensity with a lack of underlying pathology. This topic will review each of the entities considered in patients with TCH, offer pathophysiologic considerations, and discuss the diagnostic evaluation of TCH.