Thunderclap Headache in Children and Adolescents

Area of Science:

• Neurology
• Pediatrics
• Emergency Medicine

Background:

• Thunderclap headache is a sudden, severe headache, often requiring urgent evaluation.
• Epidemiology and clinical presentation in pediatric populations are less understood compared to adults.

Purpose of the Study:

• To review the epidemiology, clinical criteria, and diagnoses of pediatric thunderclap headache.
• To compare pediatric thunderclap headache characteristics with those in adults.

Main Methods:

• Literature review of pediatric thunderclap headache.
• Analysis of a single-center pediatric emergency department data.

Main Results:

• Pediatric thunderclap headache is rare (0.08% of pediatric ED visits), typically presenting as a grade 10 pain with a benign course.
• Unlike adults, most pediatric cases are primary thunderclap headaches or other primary headache types.
• Secondary causes, such as reversible vasoconstriction syndrome or intracranial aneurysm bleeding, are rare in children; infections and malignant hypertension were noted secondary causes in one study.

Conclusions:

• Severe secondary causes of thunderclap headache are uncommon in children.
• Urgent imaging and lumbar puncture are standard workups, but severe etiologies are rare.
• More research is necessary to fully understand pediatric thunderclap headache.