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Thunderclap Headaches: Symptoms, Treatment, and More

A bad headache may be an uncomfortable sharp pain that disrupts the flow of your entire day. Severe headaches can come out of nowhere. Thunderclap headaches (TCH) are a type of severe headache that causes intense pain for only a couple of minutes. Unlike a normal occasional headache, thunderclap headaches don’t have the same gradual build-up of pain.

What is a Thunderclap Headache?

A thunderclap headache is a severe occipital headache — head pain that targets the occipital nerves running through the scalp area.  This type of headache causes sudden intense pain within the first 30 seconds. Most thunderclap headaches last for about 60 seconds. In rare cases, they last for weeks or longer.

A postcoital thunderclap headache happens immediately after or while having an orgasm. Muscles in the head and neck contract during heightened arousal which leads to sudden headache pain. Those who experience postcoital thunderclap headaches may also feel a throbbing pain in the head and neck.

What is the difference between thunderclap headaches and migraines?

Thunderclap headaches are rare and sometimes confused with migraines. However, thunderclap headaches come on much faster than migraines. While nausea and vomiting are symptoms of both, these symptoms are more common with migraines. Migraines also tend to last for hours longer than thunderclap headaches.

What Causes a Thunderclap Headache?

Research shows that most secondary thunderclap headaches are symptoms of an underlying health condition. However, primary thunderclap headaches are rare and do not always have a clear cause. Most health experts believe hemorrhages in the wall of an aneurysm is the direct cause of thunderclap headaches.  

Potential causes of secondary thunderclap headaches include:

• Blood vessel tear: A decrease in proper blood flow from weak blood vessel walls may lead to a thunderclap headache or aneurysm.

• Ruptured aneurysm: Bulges in blood vessels rupture during an aneurysm leading to intense head pain.

• Stroke: During a stroke, blood vessels become blocked or rupture. They commonly occur with uncontrolled high blood pressure.

• Blood clots: Blood clots block blood vessel passageways which increases cholesterol levels. This may cause severe head pain. Some medications like testosterone or estrogen may increase your risk for blood clots.

• Tumor: The growth of a tumor in the pituitary gland and other parts of the brain may cause thunderclap headaches.

• Spontaneous intracranial hypotension (SIH): A neurological condition resulting in fluid leaking from the spinal cord. The most common symptom is an intense headache.

• Meningitis: Inflammation that occurs around the brain and spinal cord.

• Head injury: A severe headache from trauma to the head forms within hours to days after an injury.

• Medications: Certain medications like testosterone, estrogen, birth control pills, marijuana, and stimulants may trigger thunderclap headaches. Harmful drugs like cocaine may also lead to thunderclap headaches.

• Reversible cerebral vasoconstriction syndrome (RCVS): This occurs when blood vessels in the brain narrow.

• Vasculitis: Inflammation in blood vessels after an autoimmune attack can trigger a thunderclap headache and a sudden loss of vision. Those over the age of 50 have an increased risk of vasculitis. 

Some women may experience headaches in the later stages of pregnancy. Changes in hormones happen in the pituitary gland. Pregnancy may trigger a type of thunderclap headache known as the pituitary apoplexy.

What are the Symptoms of a Thunderclap Headache?

When experiencing a thunderclap headache, you may find it difficult to be in extremely bright or loud environments.

A thunderclap headache may lead to the following symptoms:

• Changes in vision

• Speech impairment

• Loss of consciousness

• Seizures

• Sensitivity to light

• Confusion

• Nausea

• Vomiting

Be sure to see a healthcare provider if you are experiencing symptoms. They may be a sign of a more serious health condition, such as a stroke or other heart conditions.

How is a Thunderclap Headache Diagnosed?

Typically, a healthcare provider will run several neurological tests including a CT scan. This type of scan may be used to detect cerebral hemorrhages and damage from a head injury. An MRI scan may show a more detailed image of brain activity. In some cases, a healthcare provider may perform a spinal tap or lumbar puncture to check for blood in spinal fluid.

How are Thunderclap Headaches Treated?

A healthcare provider will tailor your treatment based on what they believe may be causing your headaches. There are medications available to prevent blood vessel spasms. However, there is limited research on the effectiveness of these medications. 

You may be prescribed an antihypertensive medication to lower blood pressure. High blood pressure is a common cause of head pain. Most antihypertensive medications are taken daily. 

Blood pressure medications a healthcare provider may suggest include:

• ACE inhibitors: These medications are commonly prescribed after a heart attack to prevent heart failure.

• Diuretics: They clear excess fluid out of the body to prevent high blood pressure.

• Calcium channel blockers: Often prescribed to treat high blood pressure and angina, calcium channel blockers increase blood flow and oxygen to the heart.

• Beta blockers: Taking a beta blocker lowers blood pressure, slows down the heart rate, and relaxes blood vessels. 

• Alpha-2 receptor agonists: They target the central nervous system and are often paired with diuretics to help control blood pressure.

• Alpha blockers: These medications lower blood pressure rapidly to prevent symptoms.

• Vasolidators: This medication improves blood flow by opening the blood vessels.

How to Prevent a Thunderclap Headache

One of the best ways to prevent a thunderclap headache is to try to avoid activities that increase your risk of damage to your head. For example, be sure to protect your head during intense physical activities like motorcycle riding and combative sports.

Some causes of thunderclap headaches may not be as preventable as others. Complications with blood flow are a common cause of thunderclap headaches. For people with a family history of hypertension, following a heart-healthy diet may help prevent symptoms like a thunderclap headache. It’s also important to consistently engage in physical activity every day to stay healthy.

When to See a Healthcare Provider

Be sure to seek emergency help immediately if you experience a thunderclap headache. They are known to be difficult to detect. You may feel symptoms much later that signal a potential stroke or medical emergency. While all thunderclap headaches do not cause severe symptoms, serious health problems may cause a thunderclap headache.

Where Can I Learn More About Managing Thunderclap Headaches?

Through LifeMD, a licensed healthcare provider can provide tips on managing headaches and other types of pain.

Schedule an appointment today to speak with a healthcare provider about treatment options for headaches.

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