title: Thunderclap headache with orgasm: a case of basilar artery dissection associated with sexual intercourse.
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.
  
  
  METHODS
  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.
authors.affiliation: Department of Emergency Medicine, Georgetown University Hospital and Washington Hospital Center, Washington, DC, USA.
authors.forename: B Elizabeth
authors.initials: BE
authors.lastname: Delasobera
authors.forename: Scott R
authors.initials: SR
authors.lastname: Osborn
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Davis
mesh_terms: D000328:Adult; D001488:Basilar Artery / Q000473:pathology*; D006801:Humans; D018810:Magnetic Resonance Angiography; D009948:Orgasm; D012008:Recurrence; D014653:Vascular Headaches / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*