Linn F H H
Department of Neurology, Central Military Hospital and Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands.
Handb Clin Neurol. 2010;97:473-81. doi: 10.1016/S0072-9752(10)97042-5.
Thunderclap headache is an uncommon type of headache, but recognition and diagnosis are important because of the possibility of a serious underlying brain disorder. In this chapter, primary thunderclap headache in relation to other primary headache disorders and secondary, symptomatic headache disorders are discussed. Most importantly, subarachnoid hemorrhage should be excluded. The first investigation is a computed tomography (CT) scan, and, if the CT scan is negative, investigation of the cerebrospinal fluid. Other symptomatic vascular causes are intracranial hemorrhage, cerebral venous sinus thrombosis, cervical artery dissection, or a reversible vasoconstriction syndrome. These and other serious underlying intracranial disorders should be detected by magnetic resonance imaging or the appropriate investigations. The remaining patients with thunderclap headache most likely represent a primary headache disorder, including migraine, primary cough headache, primary exertional headache, or primary headache associated with sexual activity. Within the group of primary headache disorders, primary thunderclap headache represents a distinct clinical entity; it is characterized by a sudden severe headache lasting from 1h up to 10 days and not attributed to another disorder. The pathogenesis of primary thunderclap headache is still not known, but the sympathetic nervous system may play an important role.
霹雳性头痛是一种不常见的头痛类型，但由于可能存在严重的潜在脑部疾病，识别和诊断很重要。在本章中，将讨论与其他原发性头痛疾病以及继发性症状性头痛疾病相关的原发性霹雳性头痛。最重要的是，应排除蛛网膜下腔出血。首先进行的检查是计算机断层扫描（CT），如果CT扫描结果为阴性，则需对脑脊液进行检查。其他有症状的血管性病因包括颅内出血、脑静脉窦血栓形成、颈动脉夹层或可逆性血管收缩综合征。这些以及其他严重的潜在颅内疾病应通过磁共振成像或适当的检查来检测。其余患有霹雳性头痛的患者很可能属于原发性头痛疾病，包括偏头痛、原发性咳嗽性头痛、原发性运动性头痛或与性活动相关的原发性头痛。在原发性头痛疾病组中，原发性霹雳性头痛是一种独特的临床实体；其特征是突然出现严重头痛，持续1小时至10天，且不归因于其他疾病。原发性霹雳性头痛的发病机制尚不清楚，但交感神经系统可能起重要作用。
