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An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System
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Thunderclap headache: diagnostic considerations and neuroimaging features.

A M Mortimer1, M D Bradley, N G Stoodley

  • 1Department of Neuroradiology, Frenchay Hospital, Bristol, UK. alex_mortimer@hotmail.com

Clinical Radiology
|December 19, 2012
PubMed
Summary

Thunderclap headache (TCH), a severe headache with sudden onset, requires prompt diagnosis. Imaging is vital to differentiate primary TCH from secondary causes like subarachnoid hemorrhage (SAH) and other serious conditions.

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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.