Which risk factor is commonly associated with subarachnoid hemorrhage in younger patients presenting with a sudden severe headache?

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Cocaine use is a key trigger for subarachnoid hemorrhage in younger patients who present with a sudden, thunderclap headache. Cocaine causes a rapid surge in sympathetic activity, leading to acute hypertension and cerebral vasospasm. That combination can precipitate rupture of a cerebral vessel or aneurysm, producing SAH. While hypertension, smoking, and alcohol are risk factors for SAH in the broader population, cocaine use is particularly associated with SAH in younger individuals because of this potent, acute vascular impact. Recognizing cocaine use as a potential cause guides urgent evaluation and management to address both the hemorrhage and the stimulant-related vascular effects.