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¹Gazi Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı, Algoloji Bilim Dalı, Nöropsikiyatri Merkezi, Ankara, Türkiye Subarachnoid hemorrhage is a neurointerventional emergency that mostly affects young people and has high morbidity and mortality. Frequently, the first and only symptom of subarachnoid hemorrhage is a sudden and severe headache which is described as worst headache ever. 25-50% of the patients are lost due to the first bleeding or rerupture. Eighty percent of non-traumatic subarachnoid hemorrhage cases are due to the rupture of saccular aneuryms. In the history, a severe headache, known as sentinel headache, which occurs about 2 to 8 weeks before the actual bleeding can be identified and is associated with cerebral aneurysms. Sentinel headache is an important warning sign but it is still underdignosed. Every patient presenting with a thunderclap headache should be evaluated for subarachnoid hemorrhage. The first diagnostic test should be cranial computed tomography (CT) with an approximately 100% sensitivity in the first 12 hours after the bleeding. If the CT is normal, lumbar puncture and magnetic resonance imaging (MRI) should be the following tests. CT or MR angiography should be performed to detect the aneursym and for the differential diagnosis. Other causes of thunderclap headache should be considered in the differential diagnosis such as cerebral sinus venous thrombosis, pituitary apoplexy, cervicocephalic arterial dissection, acute hypertensive crisis, spontaneous intracranial hypotension and primary thunderclap headache. Treatment of the aneurysm within the first 24 hours reduces the risk of rebleeding. Open surgical clipping of the aneurysm and endovascular aneurysm obliteration are the treatment options. It should be kept in mind that early diagnosis and treatment may reduce morbidity and mortality. Anahtar Kelimeler : Subarachnoid hemorrhage, Sentinel headache, Aneurysm, Neuroimaging, Thunderclap headache, Differential diagnosis, Open surgery, Endovascular treatment