Etiologies of thunderclap headache

Most common causes of thunderclap headache:

Subarachnoid hemorrhage

Reversible cerebral vasoconstriction syndromes (RCVS)

Conditions that less commonly cause thunderclap headache:

Cerebral infection (eg, meningitis, acute complicated sinusitis)

Cerebral venous thrombosis

Cervical artery dissection

Spontaneous intracranial hypotension

Acute hypertensive crisis

Posterior reversible leukoencephalopathy syndrome (PRES)

Intracerebral hemorrhage

Ischemic stroke

Conditions that uncommonly or rarely cause thunderclap headache:

Pituitary apoplexy

Colloid cyst of the third ventricle

Aortic arch dissection

Aqueductal stenosis

Brain tumor

Giant cell arteritis

Pheochromocytoma

Pneumocephalus

Retroclival hematoma

Spinal epidural hematoma

Varicella zoster virus vasculopathy

Vogt-Koyanagi-Harada syndrome

Disputed causes of thunderclap headache:

Sentinel headache (unruptured intracranial aneurysm)*

Primary thunderclap headache^¶

* Sentinel headache due to an unruptured intracranial aneurysm is a possible cause of thunderclap headache, but supporting data are weak.
¶ There is controversy as to whether thunderclap headache can occur as a benign and potentially recurrent headache disorder in the absence of underlying organic intracranial pathology.

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Etiologies of thunderclap headache