Diagnosis

The following tests are commonly used to determine if any underlying condition is causing thunderclap headaches.

CT scan

Testing for thunderclap headaches often starts with a computerized tomography (CT) scan of the head to search for an underlying cause of the headache. CT scans take X-rays that create slice-like, cross-sectional images of your brain and head.

A computer combines these images to create a full picture of your brain. Sometimes an iodine-based dye is used to augment the picture.

Spinal tap

Sometimes a spinal tap (lumbar puncture) may be needed as well. With this procedure, the doctor removes a small amount of the fluid that surrounds your brain and spinal cord. The cerebrospinal fluid sample can be tested for signs of bleeding or infection.

MRI

In some cases, magnetic resonance imaging (MRI) may be done for further assessment. With this imaging study, a magnetic field and radio waves are used to create cross-sectional images of the structures within your brain.

Magnetic resonance angiography

MRI machines can also be used to map the blood flow inside your brain in a test called a magnetic resonance angiography.

Treatment

There's no single treatment for thunderclap headaches because so many potential causes exist. Treatment is aimed at the underlying cause of the headaches — if one is found.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Coping and support

You may find it useful to talk to other people who experience painful headaches. Try finding a support group in your area to learn how other people cope with their headache pain and discomfort.

Preparing for your appointment

Thunderclap headaches are often first diagnosed by an emergency room physician. However, in some cases when you call to set up an appointment, you may be referred immediately to a doctor who specializes in the brain and nervous system (neurologist).

If you have time before your appointment, it's a good idea to prepare. Here's some information to help you get ready for your appointment, and to know what to expect from your doctor.

What you can do

  • Write down any symptoms you're experiencing, including any that may seem unrelated to your headaches.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins and supplements you're taking.
  • Take a family member or friend along, if possible. Sometimes it can be difficult to take in all the information you get during an appointment. Someone who accompanies you may remember something you missed or forgot.
  • Write down questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. For thunderclap headaches, some basic questions to ask your doctor include:

  • What is likely causing my headaches?
  • Are there other possible causes for my headaches?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have these other health conditions. How can I best manage them together?
  • Are there any restrictions I need to follow?
  • Should I see a specialist?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there brochures or other printed material I can take with me? What websites do you recommend?

Don't hesitate to ask questions that occur to you.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • When was your first thunderclap headache?
  • Have your headaches been continuous or occasional?
  • How severe are your headaches?
  • What, if anything, seems to improve your headaches?
  • What, if anything, appears to worsen your headaches?
March 25, 2015
References
  1. Olesen J, et al. The international classification of headache disorders. International Headache Society. http://ihs-classification.org/en/02_klassifikation/02_teil1/04.06.00_other.html. Accessed Feb. 17, 2015.
  2. Approach to the patient with headache. The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/neurologic_disorders/headache/approach_to_the_patient_with_headache.html. Accessed Feb. 17, 2015.
  3. Longo DL, et al. Headache. In: Harrison's Principles of Internal Medicine. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://accessmedicine.com. Accessed Feb. 17, 2015.
  4. Headache: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/headache/detail_headache.htm. Accessed Feb. 17, 2015.
  5. DuPont SA, et al. Thunderclap headache and normal computed tomographic results: Value of cerebrospinal fluid analysis. Mayo Clinic Proceedings. 2008;83:1326.
  6. Savitz SI, et al. Thunderclap headache with normal CT and lumbar puncture: Further investigations are unnecessary: For. Stroke. 2008;39:1392.
  7. Tarshish S, et al. Teaching case presentation: Primary thunderclap headache. Headache. 2009;49:1249.
  8. Mistry N, et al. Thunderclap headache. Practical Neurology. 2009;9:294.
  9. Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.htm. Accessed Feb. 18, 2015.
  10. Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders: 2nd ed. Cephalalgia. 2004;24(suppl):9.
  11. Schwedt T, et al. Thunderclap headache. http://www.uptodate.com/home. Accessed Feb. 17, 2015.