What Is a Thunderclap Headache? Everything to Know

Thunderclap headaches (TCH) are sudden, severe headaches. Pain can peak within 30 seconds to 1 minute after the headache begins. Thunderclap headaches can be either primary or secondary. However, the majority of thunderclap headaches Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  are secondary to another health condition. A primary thunderclap headache occurs when there is no identifiable underlying cause.

Read on to learn more about thunderclap headaches. This guide includes information about the types of thunderclap headaches, symptoms, treatments, and more.

A thunderclap headache (TCH) gets its name because it starts suddenly, like a clap of thunder. Severity can peak within 30 seconds to 1 minute Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source following the onset of the headache. It can take a few hours for the headache to fade.

A secondary TCH typically results from an intracranial vascular disorder. In rare cases, a primary TCH can occur when there is no underlying condition for the headache.

A postcoital thunderclap headache (TCH) occurs either during or after sex. Experts classify this as an “explosive type” of headache Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source associated with sexual activity.

Postcoital TCH can be primary or secondary. Reversible cerebral vasoconstriction syndrome is a common cause of postcoital thunderclap headaches since sexual activity can trigger it.

The main symptom Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of a thunderclap headache (TCH) is the abrupt onset of severe, explosive headache pain. It worsens within a few minutes and can last anywhere from 5 minutes to a few hours.

Some people may experience nausea or vomiting with a TCH.

Some certain neurological signs and symptoms may indicate Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  a secondary TCH. These include:

• speech deficit
• abnormalities of the pupils
• abnormalities of the cranial nerve
• ataxia or poor coordination
• motor deficits
• photophobia or sensitivity to light
• altered mental state
• seizure

Your doctor will consider all of your symptoms before ordering tests to confirm the diagnosis.

Learn about symptoms never to ignore with a headache.

A thunderclap headache (TCH) begins with a sudden and severe onset of explosive pain. For 75% of people Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source , this pain will usually escalate within around 1 minute.

Once the initial “thunderclap” of severe pain begins to lessen, you may experience pain similar to a migraine headache. Learn about migraine.

Treatments for a thunderclap headache (TCH) include Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source :

• calcium channel blockers, such as nimodipine
• nonsteroidal anti-inflammatory drugs and other pain relievers, acetaminophen
• beta-blockers
• topiramate and lithium in lower dosages

If you experience a secondary TCH, you will require treatment for the underlying cause. Your doctor can explain what treatment options are available to you, depending on the condition.

Medical professionals may diagnose primary thunderclap headaches (TCH) when there is no identifiable medical cause.

The most common cause Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  of a secondary TCH is a subarachnoid hemorrhage. A subarachnoid hemorrhage is life threatening bleeding around the brain, typically occurring due to a burst blood vessel. Learn about what happens during subarachnoid hemorrhage.

Other possible causes of a secondary TCH include:

• reversible cerebral vasoconstriction syndrome, which is the second most common cause
• central nervous system infections, such as meningitis, sinusitis, and viral infection
• ischemic stroke
• vasculitis
• hypertensive crisis
• spontaneous intracranial hypotension
• tumors that secrete catecholamine
• pregnancy
• excessive consumption of alcohol or smoking cannabis, which can cause blood vessels to constrict

Certain drugs may also increase your risk of a TCH. These include:

• lysergic acid diethylamide
• selective serotonin reuptake inhibitors (SSRIs)
• ergot derivatives
• triptans

Sympathomimetic drugs, such as cocaine, amphetamine, and nicotine patches, may also cause TCH.

A thunderclap headache (TCH) can last anywhere from 5 minutes to a few hours Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source .

Pain will typically peak within 1 minute. Pain may then fade over the course of a few hours.

Seek immediate medical help as soon as you experience symptoms of a thunderclap headache (TCH). A TCH can result from a life threatening condition, and doctors usually Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source treat it as a medical emergency.

Your doctor may request a full medical history and conduct a physical examination. They may then assess your other symptoms to determine if you are experiencing a primary or secondary thunderclap headache (TCH).

Tests and examinations your doctor may order include Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source :

• CT scan, which can evaluate conditions such as intracranial hemorrhage, herniation, or edema mass
• lumbar puncture in cases where a CT scan is negative, as this can rule out subarachnoid hemorrhage and meningitis
• magnetic resonance angiography
• magnetic resonance venography
• computed tomography angiogram

Thunderclap headaches (TCH) are rare. Around 38–43 per 100,000 people Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  ages 18 and above experience a TCH each year.

It is important to receive treatment for a thunderclap headache (TCH) as soon as you experience it, as some causes of TCH can be life threatening.

If you do not receive treatment, you may experience complications of a secondary TCH, such as Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source :

• anterior cerebral artery dissection
• hemorrhage
• ischemia
• migraine headaches
• vasospasm from chronic TCH
• permanent neurological deficiencies
• stroke
• stupor
• mortality

It is important to contact your doctor as soon as you experience a TCH. Medical professionals usually treat this condition as an emergency.

There is no known way to prevent a primary thunderclap headache (TCH) in the first instance. However, following your treatment plan for TCH can help prevent a recurrence.

Avoiding exercise, reducing anxiety, and avoiding sex can reduce your risk of thunderclap headaches while you await treatment.

Treatment is necessary for a secondary TCH. Receiving treatment for the underlying cause may help reduce the risk of secondary TCH.

Thunderclap headaches (TCH) are sudden, intense headaches with explosive pain that can escalate within the first minute. A TCH can then gradually fade over a few hours.

There are no identifiable causes for a primary TCH. However, a secondary TCH can occur due to potentially life threatening intracranial vascular disorder.

Causes of secondary ice pick headaches include Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source :

• zoster meningoencephalitis
• meningiomas
• stroke
• multiple sclerosis

Ice pick headaches feel like brief stabs of pain. This condition most commonly affects the frontal and temporal areas.

Learn about different types of headaches.

A thunderclap headache (TCH) is a sudden and severe explosive headache. It can escalate and peak within 1 minute and may persist for a few hours.

There is no identifiable cause of a primary TCH. A secondary TCH can occur due to serious conditions, such as a subarachnoid hemorrhage.

It is important to seek immediate medical help if you experience symptoms of a TCH. It is essential to rule out potentially life threatening causes and begin treatment as soon as possible.