SHM Converge Scientific Abstract ePoster Gallery-A Case of Recurrent Thunderclap Headaches Associated With Orgasm

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This case describes a 31-year-old healthy woman with recurrent thunderclap headaches triggered by orgasm. Her headaches reached maximum intensity within one minute and recurred four times over one week. Symptoms included severe occipital pain, nausea, vomiting, photophobia, phonophobia, and a sense of global weakness, but she had no focal neurologic deficits.<br /><br />Because thunderclap headache is a neurologic emergency, the initial concern was subarachnoid hemorrhage. However, imaging showed focal narrowing of the basilar artery and left cervical vertebral artery on CT angiography, later confirmed on MRA. Laboratory evaluation for autoimmune disease and vasculitis was unrevealing. Diagnostic cerebral angiography performed a few days later showed resolution of the vasoconstriction, establishing the diagnosis of reversible cerebral vasoconstriction syndrome (RCVS).<br /><br />The discussion highlights the differential diagnosis of thunderclap headache, especially when associated with physiologic stress or sexual activity. Key considerations included RCVS, primary angiitis of the central nervous system, and primary sex headache. While headache associated with orgasm can be benign, the presence of recurrent thunderclap episodes and vascular narrowing strongly supported RCVS. This syndrome is characterized by transient multifocal cerebral arterial narrowing, often triggered by stress, and may resolve within days to weeks. Although many patients have no neurologic deficits, RCVS can lead to ischemic stroke or hemorrhage.<br /><br />The patient was discharged on verapamil for vasoconstriction management with outpatient follow-up. The case emphasizes that RCVS should be considered in patients with recurrent thunderclap headaches triggered by stress or sexual activity, even in the absence of focal neurologic findings.

Asset Subtitle

Elizabeth v. Young

Meta Tag

Author List Elizabeth v. Young, Sean Kenmore

Category Clinical Vignettes

Concept Reversible Cerebral Vasoconstriction Syndrome

Concept Thunderclap Headache

Concept Subarachnoid Hemorrhage

Concept Cerebrovascular Narrowing

Concept Primary Central Nervous System Vasculitis

Distinguished Non-Finalist

Presenter Organization University of California San Diego

Presenting Author Elizabeth v. Young

Track Adult

Keywords

thunderclap headache

orgasm-triggered headache

reversible cerebral vasoconstriction syndrome

RCVS

basilar artery narrowing

vertebral artery narrowing

subarachnoid hemorrhage differential

sexual activity headache

cerebral angiography

verapamil treatment

Reversible Cerebral Vasoconstriction Syndrome

Thunderclap Headache

Subarachnoid Hemorrhage

Cerebrovascular Narrowing

Primary Central Nervous System Vasculitis