Emilia Clarke revealed earlier this week that while the world was falling at the feet of the ultimate feminist queen she embodies on Game of Thrones, she suffered not one but two brain aneurysms that nearly killed her.

Aneurysms—which are 1.5 times more common in women—are about as scary a diagnosis as you can get. They sound innocuous enough: blood-filled sacs that form on the side of a blood vessel, almost like a berry hanging off a vine. But they’re ticking time bombs.

Aneurysms hide in the brain rarely giving off any warnings that they’re there until it’s too late. If an aneurysm ruptures (which is also 1.5 times more likely to happen in women), it can be catastrophic. “For a patient who has an any rupture like Clarke did, the reality is that 40 percent of those patients don’t survive,” says Jeremy Heit, M.D., Ph.D, assistant professor of radiology and neurosurgery at Stanford University. “Of the people that survive, a third of them will do great like Clarke and make a full recovery but the other two-thirds will be left with some degree of disability.”

In an essay for The New Yorker, Clarke shared that after she’d finished filming season one of GOT, she was in the middle of a workout when suddenly it felt as though her brain was being squeezed inside her skull. “My trainer had me get into the plank position, and I immediately felt as though an elastic band were squeezing my brain. I tried to ignore the pain and push through it, but I just couldn’t,” she wrote. She dragged herself to the bathroom “and proceeded to be violently, voluminously ill. Meanwhile, the pain—shooting, stabbing, constricting pain—was getting worse,” she continued. “At some level, I knew what was happening: my brain was damaged.”

An aneurysm rupture is often described as the “worst headache of my life”—the phrase is so consistent, doctors are taught to immediately investigate a possible aneurysm when they hear it. “The way patients describe it to me, it’s like a light switch. It’s instantaneous, like someone flicked a switch and they just have this horrendous headache,” Dr. Heit says. It’s an entirely different category of pain, he says, worse than any normal headache or even migraine. It’s so remarkable, “the vast majority of people know that there’s a problem,” he says. “If it’s something that’s really quite different or it really is the worst headache of your life, don’t mess around with that,” Dr. Heit says. “You need to get to a hospital and get evaluated.” Other key signs to look for: vomiting, dizziness, loss of consciousness, and stiffness in your neck. Some patients even have seizures.

At the hospital, Clarke was diagnosed with a subarachnoid hemorrhage (SAH)—a type of stroke and the neurological term for a ruptured aneurysm.

Doctors aren’t sure completely sure what causes aneurysms—lifestyle factors like hypertension, smoking, and drug use have all been linked to aneurysms and genetics might also play a role—or why they happen in women as young as Clarke, who was only 24 at the time. (Aneurysms typically happen in women over 35.)

Doctors do know that a nightmare gym scenario like Clarke’s isn’t an uncommon way for an aneurysm to pop. Increased blood pressure from a strenuous activity like working out—or even orgasm—can cause that quietly ticking time bomb to explode. Emotional stress even has the potential to cause an aneurysm to rupture, says Gary Steinberg, M.D., Ph.D., chief of neurosurgery at Stanford Healthcare and chair of the department of neurosurgery at Stanford University.

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