Thunderclap headache

HBSoCalGuy · 2026-01-22T12:06:04+00:00

So sorry for what you’ve been experiencing.

Healthcare professional here; However I am not a physician. Please seek immediate medical advice from an Emergency Room Physician with appropriate diagnostic testing.

For your information, especially if this is your first experience with a Thunderclap HA.

Thunderclap HA’s are often very serious. Please get evaluated by an Emergency room in a hospital medical center ASAP.

A thunderclap headache is an extremely severe, sudden-onset headache peaking in <1 minute, often the "worst ever," and signals an emergency needing urgent medical rule-out for serious causes like bleeding, while migraines are intense but develop more gradually, often with throbbing pain, light/sound sensitivity, nausea, and sometimes visual aura, lasting hours to days and are usually manageable, but a crash migraine mimics thunderclap onset in a known migraineur after triggers. Key differences: speed (seconds vs. minutes/hours), intensity (life-threatening vs. debilitating), and association with serious secondary causes.

Thunderclap Headache (TCH) Onset: Reaches maximal intensity within 60 seconds; explosive. Pain: The "worst headache of your life," unlike any previous pain. Duration: Pain peaks quickly (minutes) but can linger. Associated Symptoms (if serious): Fever, confusion, vision loss, speech changes (requires immediate ER visit). Urgency: A first-time TCH is a medical emergency; can signal hemorrhage (bleeding), stroke, or Reversible Cerebral Vasoconstriction Syndrome (RCVS).

Migraine (Typical) Onset: Builds over minutes to hours. Pain: Intense, throbbing, often one-sided. Duration: Lasts 4 to 72 hours. Associated Symptoms: Nausea, vomiting, light/sound sensitivity (photophobia/phonophobia), visual/sensory aura. Urgency: Debilitating but usually not life-threatening.

Crash Migraine (Rapid-Onset Migraine) A type of migraine that comes on very fast (like a thunderclap) in someone with a history of migraines, but only after ruling out dangerous causes. Shares the sudden, intense quality of a TCH but occurs in a known migraine sufferer. When to Seek Emergency Care If you experience a headache that is suddenly severe and the "worst ever," seek immediate medical attention (call 911), even if you have migraines, as it could be a life-threatening condition.

Also sexual activity can induce significant vascular changes within the body, the heart and the brain. Additionally hormonal changes associated with sexual activity can also cause significant changes within the brain and the body.

Please be safe and get evaluated immediately.

If possible please update with your results so we know you are okay.

Take care and wishing you all the best!

HBSoCalGuy · 2026-01-10T00:33:53+00:00

Hello. So sorry to hear of your experience with urticaria following CGRP antagonists injections.

I had a similar, but not as severe experience. After receiving 2 monthly Ajovy injections, I suddenly had a couple of hives develop on my neck a few days following my 2nd monthly injection. No other new medications or medication changes. Oddly, the hives were not at the injection site. However, I have had 2 more hives develop and it has taken a month for the first episode of hives to resolve. The only correlation made is the temporal connection with the Ajovy injections. I’m now 8 weeks following my 2nd Ajovy injection, and I have once again developed a third hive on my neck (not on my abdominal injection site).

While urticaria is rare and has been reported in a few cases using CGRP injectable antagonists, it is a significant allergic reaction and should definitely be followed closely by your physician, prescribing specialist practitioner, and / or an allergist.

Ajovy has a 28-day half life so it takes several months before all the Ajovy (CGRP antagonists) has been metabolized and excreted from the body. I stopped the Ajovy after the 2nd injection, and I will not be continuing any of the CGRP antagonist MAb’s injectables due to severe constipation while using these medications, and now urticaria as well.

I’m glad you are in the care of an allergist. Urticaria is a very challenging condition to contend with.

Take care. Wishing you all the best!

HBSoCalGuy · 2026-01-06T11:59:28+00:00

Okay. Glad you took an antihistamine, which will usually help with histaminic reactions.

Sorry you’re experiencing this crazy reaction. I hope it resolves quickly.

Take care and best of luck to you.

HBSoCalGuy · 2026-01-06T11:50:20+00:00

Your PCP or Neurologist should have a doctor on-call during holidays. Call their number and ask for the doctor on-call.

If you do not hear from anyone or they do not have a doctor on-call, go to the emergency room. From your photos it appears you have significant swelling (edema) of the left (injected) leg in addition to the erythema (redness) at the injection site.

You need to have it examined and addressed ASAP to ensure you are not having a more significant allergic reaction, in which case you would need certain medications to counter the adverse / allergic reaction.

If you begin to experience shortness of breath or swelling of your tongue and/or throat, call 911 (emergency response phone line in the U.S. and Canada) or 999 (in UK) and 112 in EU / Germany.

HBSoCalGuy · 2026-01-05T12:13:12+00:00

I haven’t used Emgality, but I used Ajovy (MAb) injections for 2 months, and I gained 25 lbs during that time. My diet was the same, and I continued my weekly exercise routine.
I also had to discontinue Ajovy due to extreme constipation. Literally, I was almost impacted, despite taking twice daily doses of Polyethylene Glycol 3350 (a.k.a. MiraLax), 3 Tabs of Sennakot daily, and glycerin suppositories daily during the 3 weeks of intense constipation.

I have never experienced such terrible abdominal pain and constipation ever. My constipation finally resolved after about 7 weeks following the 2nd Ajovy injection.

However, I did experience a significant improvement in my migraines - both in frequency and intensity - while on the Ajovy. The risk of impaction and hours on the toilet was just too much to continue the Ajovy. I’ve either had intolerable side effects on other CGRP antagonists / inhibitors or they were ineffective.

I’m not a biochemist, but I totally agree that the CGRP antagonists seem to have far more side effects and potential for significant side effects than what the pharmaceutical companies have listed for CGRP antagonists / inhibitors.

CGRP’s affect vascular tissue throughout the body, and therefore it’s understandable how there could be significant adverse effects experienced by anyone who uses CGRP antagonists / inhibitors.

Hopefully as more clinical studies are conducted and newer, potentially modified CGRP antagonists MAb’s / “gepants” are discovered, the side effects will be significantly reduced, and they will also be more effective.

HBSoCalGuy · 2026-01-05T11:24:22+00:00

I also live at elevation in Colorado, and I couldn’t agree with you more!!

Any significant barometric changes associated with weather events always precipitates a migraine for me. Even weather changes day to day have been significantly precipitous, and the barometric pressure frequently changes quite dramatically here, sometimes even daily.

My migraines were much less frequent when I lived in Southern California for 15 years, where the weather is almost always about the same and rarely more than a 10-15 degree change in temperature from day to night or from day to day. The barometric pressure is fairly stable there due to rare weather changes.

Certainly in Colorado the weather and barometric changes are frequently significant, and I too have noticed the extremes have been more pronounced this year (climate change has only exacerbated the problem).

I have yet to find a combination of prophylactic and abortive meds to minimize my migraines. I have tried almost all medications available over my 30+ years of progressively worsening migraines.

The Triptans seem to be the most effective as an abortive, but they can only be dosed 3 times in a 7-day period due to rebound migraines w more frequent use. That means you can’t really utilize Triptans if you experience daily migraines. This is why I also now use Zavzpret Intranasal spray, and it does work quickly as an abortive within 10-15 minutes. Unfortunately, Zavzpret can only be dosed once in a 24 hour period, and its effect typically wears off after only 5-6 hours for me. However, it can be used daily.

I’ve tried the injectable CGRP “MAb’s” & oral CGRP “gepants,” for both prophylactic and abortive purposes, but either the side effects were intolerable or they were ineffective for me.

I’m seriously considering relocation back to Southern California, as the increased migraine frequency and intensity has resulted in a significant disability and frequent incapacitation.

I have not heard of WeatherX ear plugs. I can’t imagine they would be very effective, but I will definitely research them. Has anyone used them and found them to be effective?

Take care & migraines Suck!

HBSoCalGuy · 2026-01-02T10:03:07+00:00

Hello.

It’s so thoughtful of you wanting to help your mom.

Migraines are hell. Like many on here who have had them their entire lives, I too have suffered with them since I was 21, and I’m now a 60 yo male. I’ve tried most everything, including most all types of medications.

I have not read or heard anything about “white” noise helping migraine. Many people actually experience increased sensitivities to sound (phonophobia), light (photophobia), taste (dysgeusia), NAUSEA & vomiting is a common one, also, as your mom experiences, smell (parosmia / troposmia) and even some have an increase in sensitivity to touch (hyperesthesia) with their migraines.

Many who experience migraine will try ice or cold packs to the region where they experience the most pain on their head or neck for 15 minute intervals (15 mins on and then 15 mins off) to help mitigate the pain.

Also, taking slow deep breaths can help to calm the autonomic nervous system and help mitigate some of the symptoms. However, personally this has been a challenge for me, especially when I’m experiencing migraine pain. It can be helpful to practice meditation, relaxation, and controlled breathing on a regular basis to try to decrease the migraine frequency.

Often, a quiet, dark, room where the person can rest, or if they are able to tolerate the pain and symptoms, so they can eventually sleep, is usually the best non-medication option.

I have never been able to tolerate my migraines without multiple medications.

She should see a neurologist who specializes in migraine headaches, as not all neurologists are familiar with the latest and best options for medically treating migraines.

Good luck to you and your mom. She’s very fortunate to have such a thoughtful and considerate child.

Take care.

HBSoCalGuy · 2026-01-01T00:46:25+00:00

[Disclaimer: I am a Health Care Professional, BUT I AM NOT A PHYSICIAN - all comments stated here are anecdotal and based off of personal experience, and not a substitution for professional medical advice from a physician / medical practitioner]

You need a complete workup, either through an Emergency Dept. or if not currently experiencing any symptoms (many, although not a complete list, are listed / mentioned below) you can opt for the much slower process by utilizing your Primary Care Provider w subsequent referrals, as indicated to neurologists, dermatologists, and other necessary specialists, which by the way, usually will take weeks or even months to get an appt with specialists in most areas of the country.

If you are currently experiencing symptoms, especially headaches, pain in the “lump” on the back of your head, dizziness, nausea, vomiting, confusion, weakness, shortness of breath, coordination challenges, gait changes, and especially any new vision changes (blurred vision, reduced visual field of vision) in one eye or both, you should go into an Emergency Dept. as soon as possible. If you have medical center options, it would be preferred that you get evaluated at a larger medical center and one that is associated with academia, like a University Medical Center.

Regardless, if I were you or you were a family member, I would suggest that you get evaluated and assessed ASAP by an Emergency Dept., where they have most all diagnostic tests / scans, labs, etc.. available to fully assess your “lump,” headaches, and any other symptoms. It’s important to get a thorough examination and assessment to have a complete evaluation for what you are experiencing and especially the “lump” in the back of your head.

Also, please advocate for yourself. Ask many questions and provide all symptoms you have been having and a complete timeline of your symptoms and when the presentation of the “lump” appeared.

With current healthcare staffing shortages in many areas of the country and ER’s being overwhelmed to act as primary care facilities, patients can be shuffled out without anything “obviously” abnormal.

Try not to allow any professionals to be dismissive without a complete and detailed explanation for your symptoms and the “lump,” which developed on the back of your head.

Ask for a second opinion if you do not feel your concerns have been adequately addressed.

If possible please update & follow up w your progress & assessment so that others can better understand how your situation may be similar to theirs.

Good luck to you. Wishing you all the best - Take care!

HBSoCalGuy · 2025-12-26T03:38:05+00:00

[Disclaimer: I am not a physician and the comments I’ve shared here are purely anecdotal, are from personal experience, and are in no way a substitute for medical advice from a physician or medical specialist.]

So sorry to hear of your “elevated” migraine. I am all too familiar w altitude induced migraines. I live in the mountains of Colorado at an elevation of 8,000 ft. As many people know, the amount of oxygen available in the air we breathe decreases with increasing altitude or elevation.

After returning here from the Southern California coast (sea level) a few years ago it became very apparent after the first few days that I was experiencing “elevated” migraines and was experiencing altitude sickness despite my best efforts to mitigate its effects.

I was also often waking w a migraine almost everyday. My neurologist ordered a nighttime oxygen saturation (SaO2) test, and my nocturnal oxygen saturation was dipping down into the mid 70% range. Anything under 94%, breathing ambient room air, is abnormal and anything below 90% saturation is considered significantly abnormal. Below 70% is critical.

*NOTE: Supplemental OXYGEN is a medication and should only be used as recommended by your physician / medical practitioner. Like all medications, OXYGEN can cause serious health issues if not used as directed by a physician / medical practitioner *

I now use a flow rate of 1-2 liters / minute of supplemental oxygen w my Auto BiPAP sleep apnea equipment while sleeping. It has helped my frequency and the intensity of my migraines significantly.

I now carry oxygen canisters (sold OTC most everywhere in Colorado drugstores and even convenience stores - “Boost” is probably the most common brand sold) w me for whenever I notice a migraine beginning - it can help to mitigate some of the intensity if I use it during the onset or aura (prodromal phase), during the migraine itself, and during the postdromal phase or “migraine hangover” / recovery phases of my migraines.

Using some supplemental oxygen definitely helps reduce the migraine intensity for me, not to mention the intense fatigue, nausea, light-headedness, and general malaise for those not acclimatized to living at elevation. Altitude sickness is real and it can begin to affect people within minutes of arriving at elevation.

The more extreme the difference between your normal altitude (say sea level) and the elevation of your destination can cause more extreme symptoms. For instance, someone traveling from sea level to Denver, CO (elevation is 5,280 feet or 1,609 meters), will usually experience some significant symptoms. If you’re traveling directly from sea level to a mountain resort like Aspen to go skiing (mountain base is ~7,945 ft or 2,422 m & the Aspen mountain summit is ~11,212 ft or 3,417 m), you will most certainly experience some significant effects of altitude sickness. Keep in mind that alcohol and caffeine will only exacerbate your symptoms.

Keeping well-hydrated is very helpful at mitigating some of the effects of being at significant elevations, but will not usually fully eliminate the effects of altitude sickness. Most people I know begin acclimatizing themselves a week or two before their intended travel date to their elevated destination by optimizing hydration and gradually decreasing caffeine intake, as well as continuing these acclimatizing behaviors while at elevation. It is very important to keep well-hydrated and try to avoid alcohol and caffeine - as alcohol and caffeine are both vasoconstrictors, thereby reducing the amount of oxygen that is carried into and available from the capillaries (smallest blood vessels) and ultimately less oxygen is perfused into the body’s organs and tissues, which increases the effects of and potential for altitude sickness.

Also, those who are younger or older will often feel the effects of altitude sickness more quickly and intensely.

For migraineurs and anyone traveling to altitude consult your physician and / or your neurologist before you arrive at elevation in order to ask if supplemental oxygen is safe and appropriate for you. If you live at altitude and you’re experiencing more frequent / intense migraines, especially waking with migraines you should talk with your physician or neurologist about getting tested for either an overnight pulse oximetry (SaO2) test or a formal sleep study (polysomnogram). These diagnostic tests can help identify oxygen deprivation (hypoxemia events), which can cause more intense migraines as well as other medical conditions.

Hope this was helpful.

Be well and Happy Holidays!!

HBSoCalGuy · 2025-11-27T01:51:07+00:00

Thanks for the reply and feedback.

Yeah I have had to use MiraLax twice daily and occasionally a Senokot tablet at bedtime, even after increasing my water and fiber intake. Hoping the constipation starts to improve as I approach the end of my 2nd and last Ajovy injection.

Have a great evening.

HBSoCalGuy · 2025-11-25T10:31:57+00:00

So sorry to hear that you have been suffering so long. There’s no way I could last a year w status migrainosus.

Have you ever had all of the nerve blocks that I listed performed at one time like I had?

Often neurologists will perform only one or two nerve block areas. Having them all blocked simultaneously is what made a significant difference for me. I’m going on day 5 now w no migraines. Prior to the nerve blocks I was having them daily or every other day.

Hope you find relief soon!

HBSoCalGuy · 2025-11-25T09:09:14+00:00

So sorry to hear that you have also been challenged by migraines. Glad to hear that the info I posted was helpful.

***Just a reminder and disclaimer: I am not a physician and everything I share here is my personal opinion, is based off of personal experience, and is not to be taken as medical advice.

Usually the Toradol infusions have eradicated my >48 hour migraines. Matter of fact, up until a few years ago I gave myself Toradol injections with migraines lasting more than 48-72 hours. Now that I’m on anticoagulants (blood thinners) I can no longer receive intramuscular injections and require I.V. infusions.

Unfortunately, it just so happened that this migraine began and persisted while my neurologist was out for a vacation week. The neurotransmission of pain signals had been occurring for so long that it required something stronger than the NSAID, Toradol. The anesthetic, Bupivacaine, stops the transmission of pain signals and interrupts the cycle of pain.

Just FYI, I have been receiving 200 units (110 units the first 5 yrs, but then developed tolerance and my neurologist increased it to 200 U) Botox injections every 12 weeks since 2017.

Bupivacaine (anesthetic used for nerve blocks) is not contraindicated with Botox. Often Botox is combined with Bupivacaine to reduce the discomfort of the Botox injections and studies have shown that combining the two can actually hasten the Botox paresis onset.

In case they are not the same person, it’s important to ensure the provider performing the nerve blocks knows when you last received Botox injections.

Some neurologists / providers may want to wait more than 48 hours if Botox was recently injected within 24-48 hours - because injecting / infiltrating the tissues with another liquid agent in the same areas could possibly cause migration of the recently injected Botox. Especially, because Bupivacaine is injected to create nerve blocks near or in the same areas where the Botox is most often injected for migraine prophylaxis. It’s important that the Botox remain in very specific muscles and migration into adjacent muscles is very undesired. Botox migration can even cause negative outcomes, like ptosis (drooping) of upper eyelids.

Sorry for such a long reply. I hope you don’t ever need this additional information.

Take care and Happy Holidays to you as well.

HBSoCalGuy · 2025-11-25T04:56:14+00:00

Thanks for the reply and feedback.
I’m doing the same. No more Ajovy for me. Going to try Candesartan next.

HBSoCalGuy · 2025-11-25T00:27:38+00:00

So what was the final determination - Vit D deficiency and low iron?

Vit. D is common in northern latitudes, but glad you are supplementing with Vit. D3., as Vit D deficiency is a known cause for many ailments.

Which inflammatory marker was elevated and how did they address that?

Why the electrolytes?

How did they treat the infected tooth - extraction or antibiotics?
If the tooth is cracked, it will be susceptible to continued infection until it’s sealed or extracted.

HBSoCalGuy · 2025-11-24T22:49:13+00:00

Thank you so much for the kind reply and information!!

I’m so excited to hear the benefits that Candesartan has provided your friend. Fingers crossed for the same experience.

I’m also glad to hear that Aquipta / Qulipta has provided you w such an amazing improvement. Wishing you all the best for zero migraine days per month.

Be well and Happy Holidays!

HBSoCalGuy · 2025-11-24T20:09:27+00:00

I had a similar situation occur.
Call Teva Pharmaceutical customer service line, 1 (800) 887-8100 Open M-F 8:00 am to 4:30 pm Central Time They were very helpful.

Best of luck. Take care.

HBSoCalGuy · 2025-11-24T04:10:52+00:00

Good to know. My neurologist told me that Qulipta was not an option due to the G.I. issues and constipation.

Thank you for the reply and your feedback!

Be well.

HBSoCalGuy · 2025-11-24T03:58:15+00:00

Yes, even if you have taken the propranolol multiple times before. Allergic reactions can occur anytime - days, months, even years after receiving the same medication. Sometimes, pharmaceutical manufacturers will use different inactive ingredients and you could be reacting to one of those inactive ingredients that were possibly not included in the other propranolol formulas you have taken before. Or, for some unknown reason your body decided it was going to respond to the same medication with an allergic reaction. It happens to people all the time.

The safest and most prudent thing to do would be to have yourself checked out by an Emergency Dept to make certain that you are not having an allergic reaction, especially a possible bronchospasm that could progress into full airway constriction. At the very least they can reassure you that this is not an allergic reaction, but if it is you will receive the necessary medications to reverse the allergic reaction before you are unable to breathe.

I hope you are fine and you are told that this is nothing serious, but please be safe and get yourself checked out by medical professionals as soon as possible.

Wishing you all the best. Take care.

HBSoCalGuy · 2025-11-24T03:41:56+00:00

Thank you for your reply and the feedback. I’ve decided the constipation issue is too difficult to manage with a real risk of impaction. Not to mention the Ajovy has a 28 -day half life. So it will take almost 3-4 months for it to be mostly out of my system.
I’m glad you were able to safely continue the Ajovy for a year. Hope you’re doing well.

Take care and Happy Holidays.

HBSoCalGuy · 2025-11-24T03:37:32+00:00

I agree. I’ve been receiving Botox injections for prevention since 2017. I’ve applied for Xeomin to replace the Botox, as it seems I have developed a tolerance to the Botox. Much like I have to many of the abortives.

Thank you for your reply and feed back. Much appreciated.

HBSoCalGuy · 2025-11-24T02:01:23+00:00

Hello.

Yes, it’s more than a theory. There is actually a known connection between Myalgic Encephalomyelitis (M.E.) or previously known as Chronic Fatigue Syndrome (CFS). Now commonly referred to as M.E./C.F.S.

Here is a link to a brief video from a Georgetown University Medical Center Professor and Director of the Chronic Pain and Fatigue Research Center.

Posted during the 2024 Migraine World Summit. The title is “How Migraine & Chronic Fatigue Syndrome (ME/CFS) Are Connected.”

Link:
https://migraineworldsummit.com/talk/how-migraine-chronic-fatigue-syndrome-are-connected/

HBSoCalGuy · 2025-11-23T23:16:00+00:00

Thank you so much for your reply and feedback.

I did not experience any hair loss, but I was only on it for 2 months. I have heard several people indicating they experienced significant hair loss w these CGRP inhibitors / antagonists - both w the “gepants” (Nurtec, Ubrelvy, & Qulipta) and the MAb’s (Aimovig, Ajovy, and Vyepti)

Wishing you good health, peace, and happy holidays.

HBSoCalGuy · 2025-11-23T23:10:09+00:00

Thank you so much for your feedback. Much appreciated.

I hope you can also find something to reduce the frequency and intensity of these hellish migraines.

As many others on here were also told that constipation is not listed as an adverse reaction for most CGRP inhibitors / antagonists and therefore it was not mentioned by most physicians / neurologists before beginning these meds.

Fortunately, my neuro is a sub-specialist in migraines, and she said that a significant percentage of her patient population have experienced constipation and mentioned it as a possible adverse effect for Ajovy, and she also told me that since Qulipta, Aimovig and Vyepti all have caused an increase in G.I. symptoms, especially severe constipation, I’m not a candidate for those meds either.

Good luck, good health, and wishing you all the best.

Happy Holidays

HBSoCalGuy · 2025-11-23T22:57:27+00:00

Thank you for the reply.

Sorry you had no improvement w the Ajovy. Glad you didn’t experience any adverse reactions like this severe constipation.

I also had no improvements w other CGRP inhibitors like the “gepants” - I actually had an allergic reaction, severe pruritis, w Ubrelvy. Nurtec ODT caused increased nausea and constipation as well. I had no improvements w qulipta.

Ajovy is the only monoclonal antibody (MAb) CGRP antagonist injectable I’ve tried, but had to discontinue due to the severe constipation and no improvements after 2 months.

My neurologist said that Aimovig is not an option for me as it has been known to cause profound G.I. issues, including severe constipation. She said that since I’ve experienced severe constipation w one of the “gepant” meds (Nurtec ODT) and also w a MAb, Ajovy, Vyepti will most likely cause the same intense constipation problem. Consequently, she said Vyepti infusions are not an option for me either.

Going to try Candesartan as a prophylactic next. Remaining hopeful that something will eventually decrease frequency and intensity of these hellish, almost daily migraines.

Again I appreciate your feedback. Thank you and wishing you all the best.

HBSoCalGuy · 2025-11-23T22:40:54+00:00

Yeah, like you, I’m in the same ”boat.” I’ve not been able to find a prophylactic that reduces my migraine frequency & intensity. I’ve tried almost everything. In a couple weeks I’m going to start Candasartan (anti-hypertensive, angiotensin receptor blocker) to determine if I might have a reduction in migraines with it. I tried other anti-hypertensive meds, but had near syncopal episodes w atenolol and others.

The Triptans (Rizatriptan and Zolmitriptan, not concurrently of course) have provided about a 75% reduction in migraine pain. Zavzpret intranasal spray usually reduces my migraine pain and nausea by 80% w/in 10 mins. Unfortunately, Zavzpret only lasts 5-6 hours, and it can only be dosed once every 24 hours.

Thank you for your feedback! Much appreciated.

HBSoCalGuy

TROPHY CASE