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Published on: June 3, 2021
Ejaculation-Triggered Reversible Cerebral Vasoconstriction Syndrome: A Case Report with Longitudinal Neuroimaging
Koji Hayashi1, Yoshihiro Ito1, Mamiko Sato1,2
1Department of Rehabilitation Medicine, Fukui General Hospital, Fukui 910-8561, Japan.
Diagnostics (Basel, Switzerland)
|August 13, 2026
Summary
This case study identifies reversible cerebral vasoconstriction syndrome (RCVS) as a primary cause of headaches during sexual activity. Early diagnosis and treatment with calcium channel blockers are crucial for managing this condition.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Headaches associated with sexual activity (HSA) are often challenging to diagnose, with a significant proportion being secondary to underlying conditions.
- Reversible cerebral vasoconstriction syndrome (RCVS) is increasingly recognized as a major cause of thunderclap headaches, including those related to sexual activity.
Purpose of the Study:
- To highlight a case of reversible cerebral vasoconstriction syndrome (RCVS) presenting as post-ejaculatory thunderclap headache.
- To emphasize the importance of neurovascular imaging in differentiating secondary causes like RCVS from primary headaches associated with sexual activity.
Main Methods:
- A 40-year-old male patient presented with recurrent thunderclap headaches post-ejaculation.
- Diagnostic workup included brain MRI/MRA to exclude other causes of headache and identify vascular abnormalities.
- The patient was diagnosed with RCVS based on clinical presentation and imaging findings, with an RCVS score of 8.
Main Results:
- Neuroimaging ruled out hemorrhage, aneurysms, and dissection but revealed segmental vasoconstrictions characteristic of RCVS.
- The patient's symptoms resolved within 10 days of treatment with verapamil, a calcium channel blocker.
- Follow-up MRA showed partial improvement in vasoconstrictions.
Conclusions:
- RCVS is a significant secondary cause of headaches associated with sexual activity, often mimicking primary HSA.
- Distinguishing RCVS through prompt neurovascular imaging is critical for appropriate management, including calcium channel blocker therapy and avoiding contraindicated medications like triptans.
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