A Case of Thunderclap Headache during Pregnancy

Headache during pregnancy is a common issue for which there is a broad differential diagnosis, ranging from common benign primary headaches to certain life-threatening conditions. Although it can be a challenging diagnosis, the presence of previously unknown or new-onset headaches can alert the clinician to the possibility of an underlying secondary process, and orient the subsequent investigation.Here, we present the case of a 33-year-old migrainous patient presenting in her 36th week of pregnancy with recurrent thunderclap headaches (TCH) in association with multifocal cerebral arterial vasospasms, compatible with a diagnosis of reversible cerebral vasoconstriction syndrome. This case serves as a starting point to briefly discuss this syndrome, its particularities during pregnancy, and its management before reviewing some other important entities that can present with TCH during pregnancy. This case also underscores the paramount importance of identifying the presence of a different pattern of headaches in a patient consulting for this symptom, in order to plan further investigation.