Isolated thunderclap headache during sex: Orgasmic headache or reversible cerebral vasoconstriction syndrome?

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
Chih-Ming HuTzu-Hsien Lai

Abstract

Orgasmic headache (OH) is an "explosive" headache that occurs at orgasm. Historically, it was considered benign with no treatment needed. Reversible cerebral vasoconstriction syndrome (RCVS) refers to a group of disorders characterized by recurrent thunderclap headache (TCH) and multifocal vasoconstriction. Patients who have RCVS often recover completely, but some may have persistent neurological deficits. We report a 34-year-old woman who presented with isolated and recurrent TCH at orgasm, which fulfilled the diagnosis of OH. However, she was post-partum and had recent exposure to ecstasy, making her symptoms highly suggestive of RCVS. Brain magnetic resonance angiography showed segmental vasoconstriction. We concluded that she could be considered to have either OH or RCVS. This patient suggests the theory that OH could be a presentation of RCVS. Given that RCVS is potentially treatable, early recognition by clinicians is vital in order to prevent devastating complications.

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Citations

Oct 27, 2012·Emergency Medicine Journal : EMJ·Carmen Andrea PfortmuellerAristomenis Konstantinos Exadaktylos
Mar 4, 2014·The Journal of Headache and Pain·Yu-Chen ChengTzu-Hsien Lai
Dec 24, 2015·Case Reports in Emergency Medicine·Christian T BraunCarmen A Pfortmueller
Jun 25, 2014·Journal of Neurology·Nicholas H Chia, Timothy J Kleinig
Sep 22, 2012·Lancet Neurology·Anne Ducros
Jun 8, 2013·The EPMA Journal·Josef FlammerAndreas J Flammer
Sep 10, 2020·Acute Medicine & Surgery·Kiyomitsu FukaguchiHiroshi Yamagami
Feb 15, 2021·Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie·M GraslandC Hentzen
Apr 20, 2021·The Neurohospitalist·Katherine Short, Hedley C A Emsley

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