We read with interest the article by Lee and colleagues reporting that nimodipine may be an effective therapy in the treatment of headache associated with sexual activity. The article postulated a pathophysiological relationship between orgasmic headache (OH) and migraine, especially with respect to vasoconstriction [1]. The causes of headaches related to sexual activity range from the benign to the life-threatening. Segmental vasospasm may exert a role in the pathogenesis of this uncommon type of headache [2]. Some authors suggest that there is a possible link between orgasmic headaches and migraines [3]. Others found that women treated for migraine displayed a high rate of sexual symptoms and distress [4].The vasoconstriction in the patient with OH seems unascertained. As shown in the paper, magnetic resonance angiography (MRA) revealed severe spasm of the Ml segments of both the middle cerebral arteries. This must be confirmed by a follow-up MRA showing no spasm in the same segment. Otherwise, an artifact is most likely to appear at such a position and should be suspected, especially when vasospasm is seen bilaterally. In this regard, comparing MRA with MRA seems more convincing than comparing MRA with digital subtraction angiography. In Discussion, however, the author stated, "However, the dramatic response to oral nimodipine treatment shown by our patient who did not have vasospasm precludes vasoconstriction as the sole mechanism underlying OH and indicates the presence of other mechanisms." We wonder what the authors meant to say-whether the patient reported here has vasoconstriction or not.
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