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Clap of Thunder: When a Headache Requires an ER Visit

Subarachnoid hemorrhage (SAH) – the medical term is as scary as it sounds judging from the term hemorrhage alone. There is indeed reason to be scared because it is a life-threatening medical condition often preceded by a “clap of thunder” headache that most individuals will dismiss as nothing more than a sudden and severe headache. This is certainly one that requires an ER visit to rule out a potentially fatal condition.

Know the Symptoms

Undoubtedly, SAH is an extremely serious medical condition with the statistics as proof – half of patients die while the other half suffer from disability after an episode. Prompt diagnosis and treatment is then a must to lessen the severity of the aftereffects of the hemorrhage.

According to the International Classification of Headache Disorders, SAH is characterized by two symptoms:

  • Headache simultaneously develops with the bleeding into the brain
  • Headache resolves after a month even without medical intervention

Its classical signs can easily be dismissed as the symptoms of less serious medical conditions, said signs of which include:

  • Sudden, explosive and unilateral (i.e., one-sided) headache described as a clap of thunder
  • Nausea, vomiting and stiff neck
  • Changes in mental status

Less commonly associated symptoms include irregular heartbeats, fever and seizure. Because these symptoms can easily be dismissed, an emergency room visit is a must to rule out subarachnoid hemorrhage; an outpatient clinic setting is not the appropriate place for its diagnosis.

Know the Causes

A subarachnoid hemorrhage usually occurs in three ways:

  • On its own

Specifically, the hemorrhage often results from a ruptured aneurysm; 80% of SAH cases are the result of it. Think of an aneurysm as a balloon with a kink, which can be a tear in the surface or a weak part of it, except that that balloon is a blood vessel in the brain.

When the tear ruptures or when the weak part finally gives out, blood flows from the blood vessel (hemorrhages or bleeds) into the surrounding brain space. The bleeding results in many symptoms like elevated intracranial pressure with signs like headache, nausea and vomiting as well as oxygen deprivation, which increases the risks for stroke and even death.

  • Trauma

Blunt force applied to the head, either from an accident or from a deliberate blow, can also result in subarachnoid hemorrhage.

In either case, getting to the emergency room at the first sign of the clap of thunder is a must! Doctors can then perform diagnostic exams like a non-contrast brain CT scan, magnetic resonance imaging, and lumbar puncture, among others.

Know the Treatment

Is there hope for an individual diagnosed with subarachnoid hemorrhage? Yes, but prompt medical attention is a must for higher chances of survival and, hopefully, for better management of disability.

If you have been diagnosed with SAH, you will be admitted to the intensive care unit where your status will be closely monitored and medications will be administered. You may also be required to undergo surgery (e.g., endovascular coiling) to prevent the bleeding from worsening.

The bottom line: Don’t dismiss that clap of thunder in your head. It may not be Chris Hemlock of Thor fame but it deserves your attention, too.

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A procedure in which the doctor inserts a small needle into the spinal cavity in the lower back to withdraw some spinal fluid for testing. Also known as a "spinal tap."