Thunderclap headache

Abstract

Severe headache of sudden onset is relatively common, especially in emergency departments, and has an extensive differential. Neurovascular disorders often present with thunderclap headache. Although the initial work-up is focused to exclude subarachnoid haemorrhage, several other serious life-threatening disorders must be considered, such as cerebral venous sinus thrombosis and stroke. Furthermore, other causes like reversible cerebral vasoconstriction syndrome are recognized more and more. In this chapter the work-up of alert, neurologically intact patients presenting with an acute and severe headache, not related to trauma, will be described.