Cephalees explosives, "en coup de tonnerre": faut-il s'inquieter?

"Thunderclap" headaches are explosive, extremely intense and sometimes associated with neurological signs or symptoms. As illustrated by the 3 case histories presented here, they are a heterogenous group as far as etiology and prognosis are concerned. They may be symptomatic of an intracranial disorder (subarachnoid hemorrhage, cerebral venous thrombosis, pituitary apoplexia) or idiopathic without any known cause and with a benign, though occasionally recurring, course. They can be spontaneous or triggered by Valsalva maneuvers (cough, exertion, coitus, ...). In certain cases of so-called "idiopathic" thunderclap headache, diffuse, multifocal segmental and reversible vasospasm of cerebral arteries has been found on neuroimaging. As headache characteristics are similar in symptomatic and benign cases, angio-MRI is recommended when CT-scan and CSF examination are normal.