A thunderclap headache is a severe headache that starts suddenly. It doesn’t gradually build in intensity. Instead, it’s an intense and very painful headache as soon as it starts. It can be a sign of a condition that can be life threatening.

Thunderclap headache is frequently described as the worst headache of someone’s life.

It’s important that you seek medical attention if you think you’re experiencing one. It may also have a benign cause that’s not life threatening, but a doctor should still check it immediately to find out what’s causing it.

The symptoms of a thunderclap headache are similar no matter what’s causing it. These symptoms can include:

  • severe headache pain that starts out of nowhere
  • vomiting and nausea
  • fainting
  • feeling as if it’s the worst headache you’ve ever had
  • pain felt anywhere in your head
  • headache pain, including your neck

It may be triggered by certain activities or have no trigger at all.

A thunderclap headache will typically reach its worst point between 30 to 60 seconds. Many times, it’ll start to go away about an hour from the point of the worst pain, but sometimes it may last for a week or more.

Postcoital thunderclap headache, which people sometimes call an orgasm headache, is a type of headache that occurs during or after sexual activity.

This may be caused by the increase in blood pressure that occurs during an orgasm, making the blood vessels dilate. Increased arousal can also cause the muscles in your head and neck to contract, which could trigger a headache.

In some cases, it happens very suddenly and is characterized by an intense, pounding headache just before or at the same time as an orgasm. You may also notice a dull ache in your head or neck, which increases in intensity as sexual excitement increases.

This type of thunderclap headache can range from mild to very severe and may last anywhere from 1 minute to 72 hours.

Though postcoital thunderclap headaches can affect anyone, certain people may be at a higher risk, including men and those with a history of migraine.

A thunderclap headache is most commonly a symptom of a subarachnoid hemorrhage, or bleeding in the brain, which can be life threatening if not treated quickly. The most common cause of this type of bleeding is a ruptured aneurysm in the brain.

Other serious and possibly life threatening causes may include:

In some cases, a physical cause for your thunderclap headache may not be found. These types of thunderclap headaches are considered to be due to an idiopathic benign recurrent headache disorder.

This headache can only be diagnosed after testing for all other causes.

While there may not be a cause for this type, there are some things that are common triggers. These triggers include:

  • sexual activity
  • physical activity
  • a bowel movement that causes you to strain
  • injury

Most thunderclap headaches aren’t the same as migraine episodes. However, it’s common for those who experience thunderclap headaches to have had frequent migraine experiences in the past.

Only tests performed by a medical professional can determine which type of headache you’re having.

If tests reveal that your thunderclap headache doesn’t have a life threatening cause, then it may be a disorder that’s considered a type of migraine headache.

The first step in treating thunderclap headaches is to determine the cause.

After a physical evaluation and gathering information about your symptoms, your doctor will usually start with a CT scan. CT scans will often be enough for your doctor to determine the cause.

However, if it doesn’t give them a clear cause, you’ll have additional tests done.

Some of these tests include:

  • Magnetic resonance imaging (MRI). An MRI can help your doctor see the structures of your brain.
  • Magnetic resonance angiography (MRA). An MRA maps the blood flow in your brain using an MRI machine.
  • Lumbar puncture. A lumbar puncture, commonly referred to as a spinal tap, removes a sample of blood or fluid from your spinal cord, which will then be tested. This fluid is the same as what’s surrounding your brain.

There are multiple treatment possibilities based on what’s causing your thunderclap headaches. They focus on treating the cause of your headache. Treatments may include:

  • surgery to repair a tear or blockage
  • medications to control blood pressure
  • pain medications to control recurrent thunderclap headaches, especially those that have a specific trigger

This isn’t a complete list of treatment options for a thunderclap headache. Your doctor will advise you of treatment options based on the specific cause of your headaches.

Many causes of thunderclap headaches are life threatening if not diagnosed and treated promptly. Conditions that may be associated with thunderclap headaches include:

You should seek medical help immediately when you first experience a severe and sudden headache of any kind. This type of headache can be a sign or symptom of a life threatening condition.

Some causes of a thunderclap headache may not be life threatening. However, only a medical professional can determine what’s causing your headache.

If you seek medical help immediately when you experience a thunderclap headache, the cause can usually be effectively treated or managed. However, delaying medical treatment could be fatal.

If you experience regular migraine episodes, you should still seek medical attention as soon as possible if you have a sudden and severe headache that’s worse than any other migraine episode in your past.

How do you know if you have a thunderclap headache?

Thunderclap headaches occur very suddenly. They cause severe pain in the head or neck, and they typically peak within 30 to 60 seconds.

If you experience a thunderclap headache, it may also be accompanied by other symptoms, including:

What happens during a thunderclap headache?

Thunderclap headaches are often caused by a rapid change in blood flow to the brain, which could be due to:

  • problems with the blood vessels
  • head injury
  • bleeding in the brain
  • hemorrhagic or ischemic stroke
  • reversible cerebral vasoconstriction syndrome

This can trigger the intense pain associated with a thunderclap headache, along with other symptoms like nausea or vomiting.

Do thunderclap headaches go away?

The pain associated with a thunderclap headache usually peaks within 60 seconds. However, it may last several minutes, hours, or even days, depending on the cause and severity.

While some people may experience a thunderclap headache only once, others might experience a recurrence over the next few days, weeks, or months.

When should you go to the emergency room for a thunderclap headache?

You should seek medical attention immediately if you experience a thunderclap headache, as it’s considered a medical emergency and may be a sign of a more serious underlying issue.

Seeking treatment early can ensure that you’re able to effectively address any health issues that could cause or contribute to this condition.