A gentleman suffered thunderclap headache after eating world’s hottest pepper chilli “Carolina Reaper” while participating in a hot pepper contest. Over next several days he experienced brief episodes of severe headache. On examination, he had blood pressure of 134/69mm Hg and no neurological deficits. Imaging study showed unexpected multifocal luminal narrowing in brain blood arteries, consistent with vasospasm.
What is thunderclap headache?
Thunderclap headache is characterized by sudden onset of severe headache which often peaks within 60 seconds and may be associated with vomiting. This type of headache is uncommon. They warn a potentially life-threatening condition, subarachnoid haemorrhage (bleeding in and around the brain) occurring due to ruptured aneurysm in brain (bulge in blood vessels caused by weakening of vessel wall).
Reversible cerebral vasoconstriction syndrome was considered as the possible cause of thunderclap headache in the above case. This syndrome can occur without an identifiable cause or secondary to an illicit drug intake (cocaine, amphetamines, and ecstasy).Patients of reversible cerebral vasoconstriction syndrome are treated with supportive care and removal of the offending agent.