A Case of Thunderclap Headache during Pregnancy

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Caroline Peyronnard MD
Elizabeth Leroux MD
Mehdi Gaha MD

Thunderclap Headache, migrainous patient, multifocal cerebral arterial vasospasms, eversible cerebral vasoconstriction syndrome,


Headache during pregnancy is a common issue for which there is a broad differential diagnosis, ranging from common benign primary headaches to certain life-threatening conditions. Although it can be a challenging diagnosis, the presence of previously unknown or new-onset headaches can alert the clinician to the possibility of an underlying secondary process, and orient the subsequent investigation.

Here, we present the case of a 33-year-old migrainous patient presenting in her 36th week of pregnancy with recurrent thunderclap headaches (TCH) in association with multifocal cerebral arterial vasospasms, compatible with a diagnosis of reversible cerebral vasoconstriction syndrome. This case serves as a starting point to briefly discuss this syndrome, its particularities during pregnancy, and its management before reviewing some other important entities that can present with TCH during pregnancy. This case also underscores the paramount importance of identifying the presence of a different pattern of headaches in a patient consulting for this symptom, in order to plan further investigation.

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1. Dixit A, Bhardwaj M, Sharma B. Headache in pregnancy: a nuisance or a new sense? Obstet Gynecol Int 2012;2012:697697.

2. Torelli P, Allais G, Manzoni GC. Clinical review of headache in pregnancy. Neurol Sci 2010;31 Suppl 1:S55–8.

3. Sharma R, Panda A. Ondansetron-induced headache in a parturient mimicking postdural puncture headache. Can J Anaesth 2010;57:187–8.

4. Macgregor EA. Headache in pregnancy. Neurol Clin 2012;30:835–66.

5. Eikermann-Haerter K, Kudo C, Moskowitz MA. Cortical spreading depression and estrogen. Headache 2007;47 Suppl 2:S79–85.

6. Cupini LM, Matteis M, Troisi E, et al. Sex-hormone-related events in migrainous females. A clinical comparative study between migraine with aura and migraine without aura. Cephalalgia 1995;15:140–4.

7. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004;24 Suppl 1:9–160.

8. Schwedt TJ, Matharu MS, Dodick DW. Thunderclap headache. Lancet Neurol 2006;5:621–31.

9. Bateman BT, Olbrecht VA, Berman MF, et al. Peripartum subarachnoid hemorrhage: nationwide data and institutional experience. Anesthesiology 2012;116:324–33.

10. Kim YW, Neal D, Hoh BL. Cerebral aneurysms in pregnancy and delivery: pregnancy and delivery do not increase the risk of aneurysm rupture. Neurosurgery 2013;72:143–9; discussion 50.

11. van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain 2001;124:249–78.

12. Chik Y, Hoesch RE, Lazaridis C, et al. A case of postpartum cerebral angiopathy with subarachnoid hemorrhage. Nat Rev Neurol 2009;5:512–6.

13. Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet Neurol 2012;11:906–17.

14. Fletcher JJ, Kramer AH, Bleck TP, Solenski NJ. Overlapping features of eclampsia and postpartum angiopathy. Neurocrit Care 2009;11:199–209.

15. Fugate JE, Ameriso SF, Ortiz G, et al. Variable presentations of postpartum angiopathy. Stroke 2012;43:670–6.

16. Singhal AB, Hajj-Ali RA, Topcuoglu MA, et al. Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol 2011;68:1005–12.

17. Demir CF, Inci MF, Ozkan F, et al. Clinical and radiological management and outcome of pregnancies complicated by cerebral venous thrombosis: a review of 19 cases. J Stroke Cerebrovasc Dis. Epub 2012 Aug 15; http://www.sciencedirect.com/science/article/pii/S1052305712002145.

18. Chen SP, Fuh JL, Wang SJ. Reversible cerebral vasoconstriction syndrome: current and future perspectives. Expert Rev Neurother 2011;11:1265–76.

19. Gilsbach JM, Reulen HJ, Ljunggren B, et al. Early aneurysm surgery and preventive therapy with intravenously administered nimodipine: a multicenter, double-blind, dose-comparison study. Neurosurgery 1990;26:458–64.

20. Yancy H, Lee-Iannotti JK, Schwedt TJ, Dodick DW. Reversible cerebral vasoconstriction syndrome. Headache 2013;53:570–6.