Thunderclap headache

Zusammenfassung

Der Thunderclap headache ist ein explosionsartig auftretender Kopfschmerz heftigster Intensität. Obwohl für den Patienten ein dramatisches Ereignis, muss er nicht unbedingt Symptom einer gefährlichen Erkrankung sein. Ziel dieser Übersichtsarbeit ist es, mit dem Thunderclap headache als eigenständige Kopfschmerzerkrankung vertraut zu machen sowie die Differenzialdiagnosen einschließlich deren diagnostischer Evaluierung darzustellen. Neben dem symptomatischen/sekundären Thunderclap headache gibt es auch eine benigne/primäre Form. Beide Formen können weder in ihrer klinischen Präsentation noch aufgrund anamnestischer Angaben unterschieden werden. Jeder plötzlich auftretende, sehr starke Kopfschmerz muss als potenziell gefährlich angesehen werden und erfordert eine prompt durchzuführende und gründliche Zusatzdiagnostik bevor die Diagnose eines primären Thunderclap headache gestellt werden darf. Zerebrale Computertomographie und gegebenenfalls Liquorpunktion sind zum Ausschluss einer Subarachnoidalblutung obligat. Zur Abklärung weiterer möglicher Ursachen sollte eine Kernspintomographie des Gehirns einschließlich MR-Angiographie durchgeführt werden. Gegebenenfalls sind auch andere spezielle Untersuchungen notwendig.

Abstract

Thunderclap haeadche is an explosive very severe headache. Although a dramatic event for the patient, it is not necessarily symptom of a dangerous disease. The aim of this review is to address the syndrome of primary thunderclap headache, the differential diagnoses and appropriate diagnostic evaluation. In addition to symptomatic/secondary thunderclap headache a benign/primary thunderclap headache exists. Symptomatic and benign thunderclap headache cannot be distinguished clinically. Every severe sudden headache has to be considered as potentially dangerous and requires prompt and thourough diagnostic evaluation before a primary thunderclap headache can be diagnosed. To exclude subarachnoid hemorrhage, brain computed tomography, and if negative, lumbar puncture are obligatory. MRI and MR angiography should be performed to rule out other symptomatic forms of thunderclap headache. In some cases it is necessary to perform additional specific examinations.

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