3 Huge distinctions between thunderclap headaches vs migraines

Head pains can be some of the worst pains known to man.

Some, like cluster headaches can even be called suicide headaches because of their persistence that may lead to madness and dark thoughts.

But they can be hard to differentiate.

In this article, we will cover thunder clap headaches and how they are distinct from migraines.

What is a thunderclap headache?

The international classification of headache disorders defines a thunderclap headache as:

A headache of high intensity that comes on quickly and has the characteristics of a cerebral aneurysm but without one”

These headaches come on quickly and reach their peak within 60 seconds.

They last for longer than 5 minutes

These headaches are associated with a brain hemorrhage and have similar symptoms except brain imaging is normal.

The conditions they resemble that need to be ruled out include:

  • Intracerebral haemorrhage
  • Cerebral venous thrombosis
  • Unruptured vascular malformation (mostly aneurysm)
  • Arterial dissection (intra- and extracranial)
  • Reversible cerebral vasoconstriction syndrome (RCVS)
  • Pituitary apoplexy

Some other organic causes of thunderclap headache are meningitis, colloid cyst of the third ventricle, spontaneous intracranial hypotension and acute sinusitis (particularly with barotrauma)

Watch this quick video to understand what a thunderclap headache is and the implications it has on your health:


Receiving the diagnosis of a primary thunderclap headache is very rare and everything should be done to rule out other possible causes that can be creating the pain. Only once they have all been exhausted is thunderclap even thought of.

Some other headaches similar to thunderclap are:

  • Primary cough headache
  • Primary exercise headache
  • Primary headache associated with sexual activity

What is a migraine?

Migraines are a headache disorder that generally lasts between 4-72 hours, are one sided, pulsate, are moderate to severe, are worse from physical activity and present with environmental sensitivities like a sensitivity to lights, sounds or smells.

Migraines generally have 4 phases but you may not experience each phase distinctly.

The initial phase of a migraines can happen hours to days before the attack and is called the prodrome.

The prodrome can present with symptoms like:

  • Confusion
  • Dizziness
  • Loss of concentration
  • Yawning
  • Fatigue
  • Cravings
  • Increased urination, etc.

After the prodrome we have a phase called an aura which differentiates the migraine with aura sufferers from the migraine without aura sufferers.

The aura is a set of symptoms that happen before the head pain phase and the most pronounced aural symptom is a visual blur, spots, dots or colors.

There may be other symptoms that present with the aura including:

  • Photophobia
  • Phonophobia
  • Photopsia
  • Allodynia
  • Increased or decreased alertness
  • Cravings
  • Other sensitivities, etc.

The aura is most often associated with cortical spreading depression which can be thought of as a power surge throughout sections of the brain followed by a blackout.

This is most often caused by instability in neurons because of oxidation, inflammation and a lack of energy generation.

If this “blackout” goes on in the visual centers of the brain, we may experience visual symptoms and so we should work towards improving nutrient availability to the brain and reducing stress on it.

The aura is usually immediately followed by the head pain phase but many experience an aura without ever having head pain.

This can be seen in cases of mild stress where our trigger levels do not rise high enough above our threshold for the heads pain receptors to be triggered.

The head pain phase is generally the most exhaustive phase of the migraine but everyone’s is different.

After the head pain ends there is a post-dromal phase or “hangover.”

The hangover is a series of symptoms thought of as a burn out or exhaustion phase.

For the average migraine brain there are a number of factors that are going on which contribute to the high levels of stress on the brain and lack of nutrients being delivered to deal with that stress.

Recent science has actually been finding that the migraine is a protective mechanism by the brain which is triggered by the body to protect the brain from damage that is already being done to it.

It is not so much that we are doing fine and our brains are fine until a migraine is triggered at which point our brain is put under stress.

Actually, our brain is continually being stressed out, raising our trigger levels.

Then once we are subjected to a stimulus that is more than our brain can handle and maintain balance or homeostasis with, a migraine triggers.

The body says it cannot maintain a normal state and goes into protection mode, revving up the body to bring repairing and growth factors to the brain.

Pain has been used as a protective mechanism by the body since the earliest of times.

When something is hurting us, our pain receptors are triggered and our reflexes pull us away from the danger.

For example when we put our hands on a hot stove, we don’t even have to go through the process of thinking to come to the conclusion to pull our hand away. Our body and its reflexes automatically do it for us and we instantly jerk.

The entire body is wired this way and our brains are the same.

What better method is there to make us stop what we are doing than to put us into migraine pain?

With all of the hormonal imbalances caused by bad lifestyle habits, food allergies and chronic burnout our culture is experiencing… Migraines are just our bodies way of saying “no,” enough is enough.

How are symptoms different between thunderclap headaches and migraines?

1. There are a few main differences between thunderclap headache and migraine but because thunderclap is really rare and mirrors many other types of head pain causes, it is not often diagnosed.

The biggest difference is in time duration.

2. A migraine may come on slowly, with pro-dromal symptoms, and aural symptoms long before the head pain. The head pain will also come on slowly and last between 4-72 hours.

But a thunderclap headache is very sudden and severe with no warning.

It rises to its peak pain within 60 seconds and can last from a few minutes to hours.

3. Migraines can be incredibly severe and crippling but a thunderclap headache is regarded as the worst headache you’ve ever had in your life and a notch above migraine.

Thunderclap headache vs migraine infographic
Understanding thunderclap headache, its signs and related conditions can be the difference between minutes of minor brain degeneration and days of unrecoverable brain damage.


If you are constantly experiencing headaches and migraines of all sorts then make sure to read our article on status migrainosus and intractable migraines here.

To get the most current holistic information on the mind and body causes of head pains then join the migraine professional community here.


Have you ever experienced a thunderclap headache? What was it like? How long did it take to get diagnosed? Let me know in the comments below.


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