• Marcelo M Valença, Luciana P A A Valença, Carlos A Bordini, Wilson Farias da Silva, João P Leite, José Antunes-Rodrigues, and José G Speciali.
• Division of Neurology and Neurosurgery, Department of Neuropsychiatry, CCS, Federal University of Pernambuco, Recife, PE, Brazil.
• Headache. 2004 Mar 1;44(3):244-8.

BackgroundThe pathophysiology of the explosive type of headache associated with sexual activity is not completely understood. Five reported cases of patients with thunderclap headache, precipitated by sexual activity, in association with concomitant cerebral arterial narrowing, were found in the literature.MethodsA 44-year-old woman with both coital and masturbatory headaches during orgasm associated with segmental reversible cerebral artery vasospasm was investigated. Cerebral anatomy and eventual spasm was documented by magnetic resonance imaging or digital angiography before, during, and after resolution of the orgasmic headache-vasospasm clinical manifestation.ConclusionFindings of cerebral arterial narrowing, presented by some patients shortly after orgasmic headache attacks, support the hypothesis that segmental vasospasm may exert a role in the pathogenesis of this uncommon type of headache. The literature is reviewed, and possible mechanisms underlying the development of orgasmic headache are discussed.

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