Differential Diagnosis for Persistent Headache after Thunderclap Headache
Single Most Likely Diagnosis
- Subarachnoid Hemorrhage (SAH) with Vasospasm: This condition is a common cause of thunderclap headache and can lead to persistent headache due to vasospasm, which typically occurs 4-14 days after the initial hemorrhage.
Other Likely Diagnoses
- Reversible Cerebral Vasoconstriction Syndrome (RCVS): This condition often presents with thunderclap headache and can cause persistent headache due to prolonged vasoconstriction.
- Migraine: Although less likely given the initial thunderclap presentation, migraine can sometimes be triggered by other conditions and lead to persistent headache.
- Post-Traumatic Headache: If the thunderclap headache was due to a traumatic event, a post-traumatic headache could persist.
Do Not Miss Diagnoses
- Cerebral Venous Thrombosis: This is a potentially life-threatening condition that can present with headache and requires prompt diagnosis and treatment.
- Intracranial Aneurysm or Arteriovenous Malformation (AVM): Although the initial thunderclap headache might have been due to a rupture, there could be ongoing risk or another unruptured aneurysm/AVM causing symptoms.
- Meningitis or Encephalitis: Infections can cause severe headache and have a high morbidity and mortality if not treated promptly.
- Pituitary Apoplexy: A medical emergency that can present with sudden headache and requires immediate attention.
Rare Diagnoses
- Primary Thunderclap Headache: A benign condition but one that can recur and cause persistent worry and discomfort.
- Cervicogenic Headache: Although less common, headaches referred from cervical spine issues could potentially follow a thunderclap headache if there was an associated cervical injury.
- Headache due to CNS Vasculitis: A rare condition that can cause persistent headache and requires specific diagnostic tests for confirmation.