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Thunderclap headache with orgasm: a case of basilar artery dissection associated with sexual intercourse
B Elizabeth Delasobera1, Scott R Osborn, Jonathan E Davis
1Department of Emergency Medicine, Georgetown University Hospital and Washington Hospital Center, Washington, DC, USA.
Background:
Headaches associated with sexual intercourse (coital cephalgia) have many different causes and are often divided in the literature into pre-orgasmic and orgasmic headaches.
Objective:
To present a case of orgasmic headache caused by a basilar artery dissection and to present a literature-based guide to the diagnosis and management of patients presenting with headaches related to sexual activity.
Case Report:
We report the case of a 34-year-old man without significant past medical history who presented to the Emergency Department with two episodes of orgasmic headache caused by basilar artery dissection.
Conclusions:
The cause of headaches related to sexual activity range from the benign to the life-threatening. Due to the dynamics of cerebral blood flow during sexual intercourse, basilar artery dissections and aneurysms should be considered in patients with sudden-onset headaches during orgasm. Appropriate brain imaging and, possibly, lumbar puncture may assist in identifying potentially life-threatening causes of coital headaches.
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