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Updated: Nov 15, 2025

Objectively Assessing Sports Concussion Utilizing Visual Evoked Potentials

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Published on: April 27, 2021

Evaluating thunderclap headache.

Chun-Yu Chen^1,2, Jong-Ling Fuh^2,3,4

¹Department of Medicine, Taipei Veterans General Hospital Yuli Branch, Hualian County.

Current Opinion in Neurology

|March 4, 2021

Summary

This summary is machine-generated.

Investigating thunderclap headache (TCH) is crucial due to subarachnoid hemorrhage (SAH) risk. Recent guidelines clarify diagnostic imaging, including CT scans and CT angiograms, to improve SAH detection and evaluation of reversible cerebral vasoconstriction syndrome.

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Area of Science:

Neurology
Emergency Medicine
Radiology

Background:

Thunderclap headache (TCH) presents as a sudden, severe headache.
Subarachnoid hemorrhage (SAH) is a primary concern and common secondary cause of TCH.
Diagnostic workup guidelines for TCH have lacked consensus.

Purpose of the Study:

To provide an updated review on the evaluation of thunderclap headache (TCH).
To highlight recent advancements in diagnosing conditions causing TCH, particularly SAH and reversible cerebral vasoconstriction syndrome (RCVS).

Main Methods:

Review of the 2019 American College of Emergency Physicians guideline for acute headache evaluation.
Analysis of updated recommendations for brain computed tomography (CT) and CT angiography.
Inclusion of information on the RCVS2 score for distinguishing RCVS.

Main Results:

Negative noncontrast brain CT within 6 hours of onset effectively excludes SAH.
CT angiogram is a viable alternative to lumbar puncture post-negative CT if SAH suspicion remains high.
The RCVS2 score demonstrates high specificity and sensitivity for identifying RCVS.

Conclusions:

Despite the thoroughness of TCH evaluation, the severe consequences of missed diagnoses necessitate diligent investigation.
Clinical awareness and targeted diagnostic tools are essential for efficient TCH workup.
Updated guidelines improve the diagnostic accuracy for SAH and RCVS in TCH patients.