Thunderclap headache
It is a symptom with specification and not a diagnosis.
The causes of TCH are:
- Primary TCH- defined as a high-intensity headache of abrupt onset, mimicking that of a ruptured cerebral aneurysm, in the absence of any intracranial pathology.
- Secondary causes
- Intracerebral bleed sp subarachnoid haemorrhage SAH from aneurysmal bleed
- Intracranial tumor complications
- Dissection of cervical artery
- Posterior reversible encephalopathy syndrome
- Reversible cerebral vasoconstriction syndrome (RCVS)- Some recreational drugs, nasal decongestants, excessive strenuous activity, sexual activity, Valsalva manoeuvre can precipitate severe abrupt headaches.
Criterion of labelling a headache as TCH are:
- Severe head pain with abrupt onset (Sudden, Extremely severe, generally defined as the worst headache ever experienced)
- Pain reaching maximum intensity in less than one minute,
- Pain lasting at least 5 minutes, and
- Headache not better accounted for by another ichd-3 diagnosis
- Multiple (2-10) excruciating, short-lived thunderclap headaches over a few days to weeks are highly suggestive of RCVS.
Points to remember
- Both primary and secondary TCH can be precipitated by sexual activity or by exercise.
- Focal neurological signs or altered consciousness should prompt physician to look for secondary causes of the headache.
- The pain could be localized, ipsilateral or holocephalic.
Materia medica of TABACUM
Allen’s key notes
- Sudden pain on right side, of head as if struck by a hammer or a club. Dim-sighted: see as though a veil; strabismus, depending upon brain troubles.
- Sensation of excessive wretchedness
- Vomiting: violent, with cold sweat; soon as he begins to move
- Terrible, faint, sinking feeling at pit of stomach
Hering Guiding Symptoms
- When Walking, indoors or outdoors, suddenly, as if struck by a hammer or club on r. side of head, throws him to left
Beoricke Materia Medica
- Vertigo on opening eyes; sick headache, with deathly nausea; periodical. Tight feeling as from a band. Sudden pain, as if struck by a hammer
Clarke Dictionary of Practical Materia Medica
- While passing urine, suddenly attacked with pains in head, so severe he screamed for assistance; immediately followed by vomiting.-Congestion of blood in head, with internal heat, and throbbing in temples.-Neuralgic headache, sensation as of sudden blows struck by a hammer.-Periodical sick-headache from fatigue or excitement.-Tightness in head as though a band stretched round it, disturbance of vision, tinnitus, and vertigo
BBCR
- Pain head as if struck with a hammer.
Differential Diagnosis of other remedies
headache pain appearing suddenly disappearing suddenly
KENT REP
Head
Plug were thrust suddenly in by increasingly severe blows- SUL AC
Sudden pains: AGAR, ARG NIT, ASTER, BELL, CAMPH, CROC, FERR, MEZ, MORPH, PHYS, SABIN, TABAC, VALER
And go, suddenly: BELL, MERC COR
COMPLETE DYNAMIS
CAUST, VISCUM, VERAT, BELL, COLOC etc are some of the common remedies in various types of sudden severe headaches.
(BELL, GLONINE, VERAT etc are closely running remedies in such conditions, each has its own keynote like BELL has throbbing, GLONINE and VERAT are more congestive.)
TABACUM and TCH
A study of the above two aspects TCH and tabacum when brought together, suggests that Tabacum can be one of the most clinically relevant remedy in thunderclap headaches given:
- It produces a sudden, very severe, abrupt headache as if struck by hammer
- With severe nausea and may be vomiting,
All these features are very suggestive that TABACUM can be a very good remedy for thunderclap headaches. However, clinicians are always encouraged to rule out other remedies before prescribing, when possible.
Reference
NB: This similarity is found only while studying the medicine from a pathological point of view. The confirmation can only be done by applying this knowledge in such a clinical condition, in a patient.
A similar pathogenetic condition may also be present in another drug, the differentiation between such drugs in similar pathologic condition is what makes homoeopathy an individualistic medicine.
This kind of approach is especially helpful when:
- The patient is not able to give refined symptoms and sensations
- One is not able to find any characteristic symptom or
- The attendants are not able to give one,
- There is time constraint or
- The physician has not seen the patient but has received a diagnosis from attendants.
- Pathology is advanced enough to wipe out the PQRS of the case.
- The patient has taken conventional treatment masking or modifying the individualistic feature. (Refer to Organon of Medicine for treatment of such cases)
The results in such prescriptions would nonetheless depend on the accuracy of diagnosis and its pathological similarity to chosen medicine.
(This post is for the practitioners of Homoeopathy and not for patients for diagnosis and treatment of the said entity.)
Aude Sapere
Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/