American Board of Internal Medicine (ABIM) Certification Practice Exam

Which syndrome is characterized by thunderclap headaches recurring over several days or weeks?

1. Cerebral vasoconstriction syndrome

2. Subarachnoid hemorrhage

3. Migraine aura

4. Cluster headaches

The correct answer is: Cerebral vasoconstriction syndrome

Thunderclap headaches are severe, sudden-onset headaches that reach peak intensity within a very short amount of time, often compared to a "bolt from the blue." They can indicate serious underlying conditions, including conditions like subarachnoid hemorrhage, but when thunderclap headaches recur daily or over several days or weeks without an acute serious event, cerebral vasoconstriction syndrome is a fitting consideration. Cerebral vasoconstriction syndrome is characterized by recurrent severe headaches caused by vasospasm in the cerebral vessels. These headaches can occur in a pattern over a period of days to weeks and are often associated with other symptoms such as nausea or altered consciousness. This syndrome may occur after certain triggers like the use of certain substances (e.g., recreational drugs) or can be idiopathic. While subarachnoid hemorrhage can present with thunderclap headaches, it usually represents a singular, acute event rather than a recurrent pattern over multiple days or weeks. In contrast, migraine aura involves visual disturbances and does not typically present as recurring thunderclap headaches. Cluster headaches tend to occur in cyclical patterns but are characterized by one-sided severe pain rather than the lightning-quick onset described in thunderclap headaches. In summary, the association of