Semin Neurol 2010; 30(2): 192-200
DOI: 10.1055/s-0030-1249229
© Thieme Medical Publishers

Abrupt-Onset Severe Headaches

Yo-El S. Ju1 , Todd J. Schwedt1
  • 1Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
Further Information

Publication History

Publication Date:
29 March 2010 (online)


Thunderclap headache, a severe headache which is maximal in intensity at onset, is associated with numerous underlying disorders, including subarachnoid hemorrhage, unruptured intracranial aneurysm, cervical artery dissection, cerebral venous sinus thrombosis, stroke, intracranial hemorrhage, reversible cerebral vasoconstriction syndrome, and reversible posterior leukoencephalopathy. After exclusion of all possible causes, thunderclap headache may be considered a primary headache. This review summarizes the diagnostic considerations and clinical approach to thunderclap headache, with particular emphasis on the reversible cerebral vasoconstriction syndromes.


Todd J Schwedt, M.D. 

Assistant Professor of Neurology and Anesthesiology, Washington University School of Medicine

660 South Euclid Avenue, Box 8111, St. Louis, MO 63110