What are thunder-type headaches and why do they appear?

Thunder-type headaches can be accompanied by nausea, vomiting, fever, and impaired consciousness. We explain why they are produced and how they are treated.

Last update: 02 August, 2021

Thunder-type headaches, also called thunder headache, constitute a very intense type of pain. The name is because appear suddenly and severely.

Its maximum intensity occurs at approximately 60 seconds. Contrary to what happens with other types of headaches, they are a warning sign of a neurological problem. That is why they are considered an emergency.

The truth is that their incidence is low, but when they appear they usually indicate seriousness. Therefore, in this article we explain what thunder headaches are, why they occur and how they are treated.

What are thunder-type headaches?

Thunder-like headaches They are those of great intensity and sudden onset. In fact, they reach their maximum intensity in the first minute.

As an article by IntraMed, it is estimated that they affect around 43 out of every 100,000 inhabitants in developed countries. Therefore, its incidence is relatively low. However, they are a sign of seriousness.

Its main cause is subarachnoid hemorrhages. However, they can appear for many other reasons. The vast majority of situations that cause them are life-threatening if a prompt approach is not initiated.

According to the specialists of the Mayo Clinic, they can accompany other symptoms, such as nausea, vomiting or fever. In some cases the mental state is altered or there are seizures.

What can cause thunder headaches?

Thunder-type headaches are usually secondary to structural damage to the brain. The main cause is subarachnoid hemorrhage. This is bleeding that occurs between the brain and the meninges, in the so-called subarachnoid space. It is a very serious life-threatening situation.

Another cause is strokes of any kind, whether they are ischemic (due to interruption of blood flow) or hemorrhagic. The latter are the result of a tear or rupture of a cerebral artery.

Cerebrospinal fluid leakage, hypertensive crisis, or certain infections They can also cause thunder-like headaches. Among the infectious pictures, meningitis and encephalitis stand out.

The central nervous system conditions that cause these headaches are serious conditions.

Risk factor's

Sometimes thunder-like headaches don't even have a specific cause, and it's not really clear why they happen. They are called primary or idiopathic. It is a specific type that affects young people.

In these cases, there are certain factors that can act as triggers. As an article by Harvard Medical School, coughing, exercise and sexual activity are some of the triggers.

On the other hand, it is important to note that there are recurring presentations. These are cases in which there is involvement of the cerebral arteries. Having this condition increases the risk of brain bleeds and nervous inflammatory processes.

Possible complications

Complications of thunder headaches depend on their cause. The greatest danger is severe brain damage due to bleeding or ischemia.

This type of headache should always be treated as an emergency. Although in a percentage of cases they appear sporadically and remit, it is always essential to rule out that there is no brain injury.

Diagnosis of thunder-type headaches

Thunder-type headaches are usually identified clinically. The diagnosis is made with the symptoms reported by the patient.

It will also be decisive to check that the patient is stable or if he has any neurological deficit. This will require monitoring of their vital signs and a good physical examination.

The first test that is usually performed is a CT scan. It allows images of the brain to be obtained to see if there is an injury, such as bleeding. MRI is also very helpful.

An MRI angiogram will check the condition of the blood vessels. Lumbar puncture may be helpful in cases where infection is suspected.

How are thunder-type headaches treated?

Treatment for thunderclap headaches depends on the cause. In cases in which no specific etiology is determined, despite having carried out an exhaustive study, pain relievers can be used.

When the pain is due to an ischemic stroke, you will have to act quickly. If the stroke has been evolving for less than 4 hours, fibrinolysis can be attempted. It consists of trying to undo the clot that is blocking the affected artery.

In other cases, a thrombectomy may be performed. It is an intervention that seeks to remove the clot. Hemorrhagic strokes often require surgery.

Infections, such as meningitis or encephalitis. They must be treated according to the microorganism that produces them. Since viruses are common causes, antivirals may be administered. If it is a bacterium, antibiotics will be administered.

The surgical approach will be necessary if a clot is to be dissolved or an arterial obstruction is to be released.

Prevention and recommendations

Thunder-type headache is almost impossible to prevent. It appears without warning, causing a very intense discomfort.

Cardiovascular risk factors, such as those just noted, increase the risk of arterial damage to the brain. So you have to try to act on them. In this way, the chance of having a stroke or subarachnoid hemorrhage can be reduced. A healthy lifestyle is essential.

What we need to emphasize again is that thunder-type headaches should be treated as an emergency. They are indicative that there may be a structural injury. In fact, its main cause is subarachnoid hemorrhages.

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