Thunderclap Headache When the risk of doing nothing is too high
The cause of thunderclap headache should be considered to be aneurysmal subarachnoid haemorrhage
until proven otherwise. The diagnostic work up involves urgent non-enhanced CT of the brain (with
CT angiography if immediately available), then possibly a lumbar puncture, then cerebral arterial and venous
imaging with either MRI or CT if each preceding investigation has yielded a normal/negative result.
Reversible cerebral vasoconstriction syndrome is usually characterised by recurrent thunderclap headaches
and multifocal, multi-vessel segmental cerebral artery vasoconstriction that usually resolve within 12 weeks.
It can be associated with neurological complications including intracerebral haemorrhage and cerebral
ischaemic infarctions.
Modern Medicine – April 2018
