Thunderclap headache, big rise in blood pressure

by Linda Christina
(Lutz, Florida, USA)

I am 50 years old, female. Quit smoking 9 weeks ago. Have a history of high blood pressure, well managed with Ziac.

Yesterday I had a dental deep cleaning on the right side of my mouth - don't know if that's related. But this morning, I had a sudden and severe headache that hit me like a sledge hammer in the back right side of my lower skull, right above my neck. Within a minute or two, it had spread to the whole right side of my head, and within 30 minutes it was my entire head.

This was not a migraine - I know what those are like. I get them infrequently and they always involve an aura. My blood pressure has gotten better since I quit smoking, yet it was 182/92.

I called my family doctor and he had me take another Ziac and a Xanax and told me to call him back in an hour. After lying down for an hour, I took the pressure again and it was still 176/102. The headache had not eased, in spite of Advil and Fioricet. He had me come in to his office, gave me a different type of blood pressure pill and had me lie down in a room for an hour, with a nurse taking my pressure every 15 minutes. It went down quite a bit in an hour, to 130/92. He told me to stay home from work, go home and get some rest, and if it happens again to go to the ER.

It is almost midnight now, I still have a milder headache, and my BP is 132/89. Could the dental work have caused this episode?

Another thing to consider is that my sister, who is 3 years younger than me has had 3 aneurisms and has had a shunt implanted to drain fluid. She has been told it is congenital weakness in the blood vessels in her brain and she is at risk for further arachnoid hemorrages. Needless to say, I am worried. This has never happened to me and I am afraid it might happen again. I look forward to hearing from you.



Hi Linda,

Thanks for the complete history..it makes it easier for me to see what is going on.

Your doctor was on the right track yesterday as getting the blood pressure down was important. I am glad that you stayed in his office until it was under better control. Although this sounds like it could have been a high blood pressure headache, there are a couple of flags here.

First of all you have a family history of aneurysm which puts you at risk for one. Other things that increase your risk are the history of hypertension that may or may not be under good control and the history of smoking. Even though you recently quit (what ever you do, NEVER start again) this is your biggest risk factor. Many of my patients who have had aneurysms only had smoking as a risk factor.

Secondly, you had a change in your headache profile. Although, as I said, it would be easy to put it down to a blood pressure issue, none the less you need imaging. It would also be easy to say you had a bad migraine, triggered by dental work and your blood pressure went up because of the migraine...but the headache was somewhat refractory to treatment.

I would recommend you speak to your doctor today and request an MRI of the brain and an MRA which looks at the arteries and rules out aneurysm. It doesn't matter if you had these done before, this new incident means you should have them done now, within a day or two. A CT of the brain is not sufficient as it doesn't catch small aneurysms.

The problem with aneurysms is that the majority of the time, people have a "sentinal" headache a few days or weeks before a rupture.

Remember, your risk of stroke is higher too because of above factors and a history of migraine.

Best of luck!

Mary Kay Betz MS RPA-C

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Thunderclaps, and resulting vertigo

by Debbie

Basilar Aneurysm (large dark circle in center)

Basilar Aneurysm (large dark circle in center)

Hi, about 4 months ago I experienced thunderclap headaches two nights in a row. I literally saw an explosion going off in my head and it was excruciating.

The thunderclaps have not recurred since, however I am now waking up in the middle of the night seeing the room spinning and for several hours after am nauseous.

I am 55 years old and healthy. I have not seen a medical provider (uninsured) so have had no treatment. I do suffer degenerative neck disease from a flipover accident in the 70's.

I appreciate any input you may have as to what is going on.



Hi Debbie,

I realized cost is an issue but a thunderclap headache is something that has to be taken seriously. And here is why...many times this headache is the "herald" to a aneurysm that is going to rupture.

Now I don't mean to frighten you but if you have a family history of stroke or aneurysm, or if you have a history of smoking, these all increase your risk. Your age is a risk factor too.

If the aneurysm is a basilar artery aneurysm it can be associated with vertigo and nausea.

Please go to the emergency room. A CT of the brain will find it and they are not as expensive as an MRI. Many hospitals now have payment programs for ER visits and they have foundation funds for more serious cases.

Good luck..
Mary Kay

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My Husband have a Headache for a Month Now

by Melanie
(Orlando,FL United States)


My name is Melanie and really one too now what can cause the Headache's?My husband is 25 yrs and he's being having a headache every day and is being a month and a half we tried all different kind of pills but nothing.Am getting scare of this headaches right now,on tuesday when i came from work and him too i cook food to him like everyday and suddenly his nose starts bleeding and this never happens too him,and it last for 10mnts. after the nose stops bleeding he had a serious pain under his rigth arm what is causing all this pain to him he is really all this pain?



Hi Melanie,

A headache associated with a nose bleed could be uncontrolled hypertension (high blood pressure). This is something that needs to be treated immediately as the blood pressure affects every artery in the body, including the ones surrounding the heart and the small ones in the brain.

Believe it or not, I have seen a case of a 27 year old male who almost had a stroke with the same symptoms. He ended up fine but was having an arterial dissection. Now I don't want to frighten you, but he does need to see a doctor soon. If you a really concerned you can always go to an urgent care center or to the emergency room.

Good luck,
Mary Kay Betz MS RPA-C

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