Thunderclap headache: diagnostic considerations and neuroimaging features.

Area of Science:

• Neurology
• Radiology
• Emergency Medicine

Background:

• Thunderclap headache (TCH) presents as an acute, severe headache reaching maximum intensity at onset.
• TCH can be primary (no identifiable cause) or secondary (due to an underlying condition).
• Distinguishing between primary and secondary TCH is critical for appropriate patient management.

Purpose of the Study:

• To review the wide-ranging potential diagnoses for secondary TCH.
• To highlight the crucial role of imaging in identifying underlying causes of TCH.
• To guide radiologists on imaging features for diagnosing various TCH etiologies.

Main Methods:

• Review of imaging features for TCH diagnosis.
• Emphasis on initial computed tomography (CT) findings.
• Discussion of magnetic resonance imaging (MRI) and angiographic imaging characteristics.

Main Results:

• Subarachnoid hemorrhage (SAH), particularly aneurysmal SAH, is the most common secondary cause of TCH.
• Other significant secondary causes include reversible cerebral vasoconstriction syndrome (RCVS), cervical artery dissection, and cerebral venous sinus thrombosis.
• Non-vascular causes such as colloid cysts and spontaneous intracranial hypotension can also present as TCH.

Conclusions:

• Accurate diagnosis of TCH relies heavily on prompt and appropriate neuroimaging.
• Radiologists must be aware of the diverse differential diagnoses for TCH.
• Systematic imaging evaluation is essential to rule out life-threatening secondary causes of TCH.