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J Emerg Med. 2012 Jul;43(1):e43-7. doi: 10.1016/j.jemermed.2009.08.012. Epub 2009 Oct 8.

Thunderclap headache with orgasm: a case of basilar artery dissection associated with sexual intercourse.

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1
Department of Emergency Medicine, Georgetown University Hospital and Washington Hospital Center, Washington, DC, USA.

Abstract

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.

PMID:
19818575
DOI:
10.1016/j.jemermed.2009.08.012
[Indexed for MEDLINE]
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