most of you have likely experienced some sort of headache during your lifetime and even though some of the most common headaches such as tension headaches and migraines can be extremely annoying and painful they don't typically cause a major problem with this wonderfully important structure that we call the human brain however there is a phrase that most ER clinicians don't love hearing from their headache patients and that is this is the worst headache of my life and it came on out of nowhere this this is an extremely concerning warning for the Thunderclap headache and this is an extremely painful and serious headache because it can be life-threatening and so let's find out why a thunder clap headache is kind of what it sounds like a severe headache that strikes suddenly like a clap of thunder and when I say suddenly we are talking reaching its full intensity of pain within 60 seconds imagine just sitting there drinking your morning coffee watching Institute of human anatomy videos and Bam out of nowhere you're hit with the worst headache of your life now there are cases where it can take longer than 60 seconds but the key is this sudden and severe onset so what could be causing this violent onset of pain well there are multiple causes of a Thunderclap headache but the most common cause is a brain bleed known as a subarachnoid hemorrhage and this is bleeding into a space called the subarachnoid space that we'll take a look at on the cadaver dissection here we are looking at the top of the left side of the head and I'll start by removing the scalp kind of cool take a look at that and underneath you can obviously see the skull that I'm also going to remove now a lot of students expect that when you remove the bone that you're going to see the brain directly underneath but we also have protective connective tissue coverings that surround the brain and these connective tissue coverings are called the meninges meninges just means membranes and these meninges will help us to understand a subarachnoid hemorrhage and ultimately this Thunderclap headache the meninges are made up of three layers the first one that you are seeing here is the thickest layer called the duramater and it actually translates to tough mother the anatomist of old mistakenly thought that these were the mother tissues because they thought all the other tissues of the body were derived from the menines they obviously ended up being wrong however the name stuck but if I reflect the duramater you'll see another thinner layer that's actually collapsed onto the brain and this is called the arachnoid Mater it looks like this Saran wrap on top of the brain but arachnoid meaning spider-like mother because it has some little tissue beams that resemble spider webs and I said collapsed onto the brain because normally in a living person this arachnoid would be pushed up against the dura because there would be fluid specifically cerebral spinal fluid between the arachnoid or underneath it but also just between the arachnoid matter and the deepest meningi known as the pomat now the pomat means delicate mother and it is the thin transparent connector tissue layer that adheres to the surface of the brain and spinal cord that you can't distinguish the Pia from the brain with a naked eye and here is another view of the meninges that gives you an idea of how it surrounds the brain here you've got the dura right here and with my probe right here you can see that arachnoid Mater as well and so we have this space between the arachnoid Mater and the pomor where the CSF flows to create a protective hydraulic cushion for the brain and this space because it is underneath the arachnoid Mater it is referred to as the subarachnoid space and this is where we get that subarachnoid hemorrhage or the bleeding that ultimately leads to the Thunderclap headache and think about this subarachnoid space it surrounds the whole brain even goes down and surrounds the spinal cord so a major bleed into this space could cover a significant portion of the brain and if the bleed in continues eventually this will start to put pressure on and compress the brain and will lead to other symptoms besides just the severe headache such as loss of consciousness vomiting and neck pain or stiffness because again that subarachnoid space will continue around the spinal cord and if left untreated this can lead to death but taking a quick break from all the Gloom Doom and death from brain bleeds let's quickly talk about bringing life to your colon by saying thank you to the sponsor of today's video seed seed's DS1 daily sin biotic iotic is a broadspectrum probiotic and Prebiotic that is designed to support your gut health skin health and much more this is delivered in seeds via cap which is this cool capsule in capsule delivery system that acts as a barrier to oxygen and moisture as well as protects against stomach acid enzymes and bile salts so that the probiotics actually make it to the colon where they belong with seed you get 24 clinically and scientifically studied strains which is the first of its kind seed is also dedicated to sustainability and with your first purchase you'll get a glass jar that is infinitely refillable and the monthly refills come in compostable biodegradable and recyclable packaging and the packaging is just the beginning because once inside your wonderful colon these probiotic strains can support gut barrier Integrity improve gut motility and ease the process of stool evacuation if you will so if you're interested you can get 15% off your first month supply of seeds daily synbiotic by clicking the link in the description and using our code an at checkout and now back to the Thunderclap so what caused the bleeding into the subarachnoid space in the first place well we can blame a brain aneurysm for that one specifically a sacular aneurysm an aneurysm refers to a bulging artery and a sacular aneurysm is a specific type of aneurysm where the artery balloons out on one side creating a sacklike pocket hence the name now there are a couple problems with an aneurysm one is that an aneurysm like this can quietly grow over time meaning there are no symptoms and the person has no idea they have one kind of creating somewhat of a ticking Time Bomb which leads to problem number two as the anur and balloons or stretches it weakens the wall of the artery making it more susceptible to bursting or rupturing which as we've learned today can suddenly lead to the subarachnoid hemorrhage and this Thunderclap headache now let's talk about treatment clearly if anyone has a Thunderclap headache the first step is to get to an ER ASAP but unfortunately According to some populationbased studies anywhere from 18 to 24% of patients with a Thunderclap headache caused by this subarachnoid hemorrhage died suddenly prior to even being evaluated in the hospital but those that do make it to the hospital they will work to stabilize the patient which would include blood pressure control IV fluid administration Imaging such as a head CT to confirm the bleed and if they find a bleed the treatment will likely involve surgery to fix the ruptured aneurysm and stop the bleeding now there are some cases of a Thunderclap headache that are not caused by a subarachnoid hemorrhage so those would obviously be managed differently but those causes are less common and for another video now I want to be clear about something even though it is kind of freaky that an unknown aneurysm can suddenly rupture and bleed into the subarachnoid space and cause this Thunderclap headache these headaches caused by this mechanism are not very common in a systematic review and meta analysis the overall Global incidence was about 7.9 per 100,000 people per year which is about 0.79% so clearly not very common but even still is there anything we can do to reduce our risk of this well yes and in a way this is really about reducing your risk of developing an aneurysm cigarette smoking appears to be the most important preventable risk factor heavy smokers have a higher risk than lighter smokers and people that stop smoking will decrease their risk over time hypertension or high blood blood pressure is also a major risk factor there is obviously a genetic component to your blood pressure there are also multiple things you can do in your life to help reduce your blood pressure as well as medical management and I have a much more detailed video on how you can lower your blood pressure that I'll link at the end moderate to heavy alcohol consumption also appears to increase one's risk key point is moderate to heavy or excessive alcohol consumption now again the point of this video was not to have you all walk around all day worried about having a ruptured aneurysm that results in a Thunderclap headache again they aren't very common plus the topics we discussed to help reduce your risk avoiding smoking managing your blood pressure avoiding excessive alcohol intake all of those are just good health practices that will also reduce your risk of many other health conditions so hopefully you learn something new and interesting about this thunder clap headache and even some cool anatomical structures that relate to the subarachnoid spaces and how we protect our brain with those cool menis but thank you for watching and supporting the channel and we'll see you in the next video