Acute ‘thunderclap’ headache

Question 1

What is Acute thunderclap headache

Answer 1

This is a sudden severe headache

Question 2

Causes

Answer 2

1) Enlarging aneurysm—an enlarging aneurysm or vascular malformation can cause acute headache
2) SAH—the pain is typically occipital, localised at first then generalised and may vary in intensity
3) Meningitis—must be considered if the headache is generalised, especially in the presence of malaise, fever and neck stiffness: the ache, which is constant and severe, may begin abruptly

Question 3

Considerations

Answer 3

For chronic headache, space-occupying lesions including subdural haematomas must be considered.

Since headaches tend to decrease with age, headaches developing in the elderly should be viewed with suspicion and this includes considering temporal arteritis (TA).

Benign intracranial hypertension should be considered, especially in young obese women.

The dangerous cryptococcal meningitis can be difficult as the CT scan may be normal.