Thunderclap headache attributed to reversible cerebral vasoconstriction: view and review

Abstract

Thunderclap headache attributed to reversible cerebral vasoconstriction (THARCV) is a syndrome observed in a number of reported cases. In this article we reviewed this new headache entity (idiopathic form) using the clinical-radiological findings of 25 reported patients. In this series of patients 72% were women, the mean age at the onset of first headache episode was 39.4 ± 2.3 years. In addition to the sine qua non condition of being abrupt and severe (thunderclap) at the onset, the headache was usually described as being explosive, excruciating, or crushing. The feature of pulsatility, accompanied or not by nausea was described by 80% of the patients. Forty percent of the cases manifested vomiting and 24% photophobia. Usually the headache was generalized, and in three cases it was unilateral at least at the onset. In 21 of 25 patients (84%) there was at least one recurrence or a sudden increase in the intensity of the headache. A past history of migraine was present in 52% of the patients. Precipitating factors were identified in 56% of the patients. Sexual intercourse was described by six patients. Of the 25 patients with THARCV syndrome studied, 12 (48%) developed focal neurological signs, transitory ischemic attack (n = 1), or ischemic stroke (n = 11, 44%), and two (8%) of them manifested seizures. The THARCV syndrome is a neurological disturbance perhaps more frequent than expected, preferentially affecting middle aged female migraineurs, and having an unpredictable prognosis, either showing a benign course or leading to stroke.

Sexual Behavior, Function and Satisfaction in Headache Associated with Sexual Activity: A Systematic Review of Literature

“…In contrast to several hundred patients of intercourse HSA, there are only a total of 31 masturbatory HSA collected in this study [24] [40]. In United States, the National Survey of Sexual Health and Behavior [58] has shown that the frequency of masturbation in alone or with partners ranges from 27.9% to 68.6% of men whereas approximately 20% of women in each age group in the past month.…”

“…First, an outnumbered orgasmic type of headache is characterized in overall HSA patients [14] [15] [16], [26]- [34]. Second, intracranial vasospasm is occasionally found in primary and secondary HSA [22] [23] [24]. Third, Charavaty [25] reported a woman (Case E) who acknowledged her HSA occurred under a passionate sex with husband during shower.…”

“…In this study, the masturbatory HSA exclusively occurs at orgasm [24] [25] [26] [31] [35]- [40] and is therefore suggested to share a hypersympathetic basis along with a different process for pain occurrence with intercourse HSA. Two findings may account for a relative lower frequency of masturbatory HSA.…”

“…Two studies were excluded; type of headache was recorded in only 1 out of 6 patients in one study [24] and only orgasmic headache patients were enrolled in another study [29]. In the remaining 10 studies, the frequency of pre-orgasmic headache was 0% -57.9%, orgasmic headache 26.3% -100%, postorgasmic or postural headache 0% -19.2%, mixed headache 0% -13.3%, and uncertain headache 0% -4.8% of HSA patients.…”

“…In the series of Frese et al [26], HSA occurred under specific act of intercourse in 5 (8.4%) out of 51 patients, including kneeling position in 2, supine position in 2, and fellatio in 1 patient respectively. In the series of Valença et al [24], a 44-year-old woman suffered HSA under masturbation or intercourse with her husband in standing position. In the series of Porter and Jankovic [30], a 40-year-old man suffered HSA in kneeling position.…”