All headaches are not created equal, says board-certified neurologist and headache specialist Brian M. Grosberg, MD. One type of headache—thunderclap headache—not only causes intense pain but may indicate a far more serious condition.
Unbearable pain that seemingly comes out of nowhere and peaks to a maximum intensity within seconds to a minute. People often describe it as the worst headache they’ve ever had. Thunderclap headache may be accompanied by nausea and vomiting, altered mental state, seizure and changes in speech or cognition.
A thunderclap headache is classified as a secondary headache. It can stem from a wide range of causes including trauma or injury to the head…a vascular (stroke or aneurysm) or nonvascular disorder (tumor or meningitis)…a ruptured cerebral aneurysm…substance misuse or withdrawal…a problem with any of the structures in the head or neck, even teeth if you grind them…a psychiatric disorder or problems with cranial nerves.
What to do: Head to the emergency room or call an ambulance immediately. There’s no way to tell without an emergency room evaluation, often including a CT scan and other tests, the headache’s cause and next steps.
What to expert in the ER: To determine what type of diagnostic testing is appropriate, your doctor will look for worrisome red flags using the mnemonic “SNOOP”…
Systemic symptoms, such as fever, weight loss, rash, chills, night sweats and secondary headache risk factors.
Neurologic symptoms or abnormal signs, such as confusion, weakness or numbness on one side of the body, or problems with speech or language.
Onset, with concern stemming from a sudden, abrupt severe headache.
Older than age 50 because new and progressive headaches in middle age could be a sign of certain conditions, such as giant cell arteritis, an inflammatory disease affecting the large blood vessels of scalp, neck and arms.
Progression—the frequency or severity pattern to the headaches or whether they result from a change in position, such as when going from lying down to standing.
Testing can be extensive, especially in the case of an emergency situation for a thunderclap headache. It may progress from imaging and blood tests to a lumbar puncture and biopsy and consults with other specialists.
