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Thunderclap headache was the subject of a recent review in this journal, in which the pathophysiology was linked to segmental vasospasm.1 Specifically, the abrupt onset of the headache was linked to vasospasm caused by neurogenic rather than biochemical mechanisms. Hyperventilation can probably induce generalised vasospasm through alkalosis of the cerebrospinal fluid.2 We recently saw a patient where hyperventilation or exertion caused thunderclap-like headaches.
This previously healthy 15 year old boy was admitted to Leiden University Medical Centre because of acute (that is, maximum severity within one minute), severe left sided headache associated with, successively, a numb and tingling sensation in the right arm and leg, weakness of the right arm for 30 minutes, and difficulty in speaking. Four weeks earlier, after running for several minutes to catch a train, he suffered an acute, severe bi-frontal, throbbing headache, which subsided within minutes …