Abstract

Headache is a common complaint encountered in the emergency room and can be caused by life threatening serious diseases. After history taking & examination, brain imaging and/or spinal fluid examination are mandatory for patients with first ever severe headache or abnormal neurological findings. In addition, the physician’s roles in the emergency department are to control the pain and to refer these patient to follow up visits to start effective therapy for future recurrence. Thunderclap headache is a headache that begins suddenly and is maximum in intensity at onset. A lot of intracranial illnesses cause thunderclap headache. For example, there are subarachnoid hemorrhage, cerebral venous sinus thrombosis, stroke, spontaneous intracranial hypotension, and reversible cerebral vasoconstriction syndrome. However, more than half of those with thunderclap headache have normal imaging and cerebrospinal fluid examination and primary thunderclap headache can be suspected in case with prolonged symptom. Primary cough headache and exertional headache is suspected in the cases with recurrent headaches in a special situation.