A 50-year-old woman suffered an excruciating thunderclap headache while defecating. She reported 13 years of coital cephalalgia (CC) with thunderclap occipital throbbing headaches occurring at orgasm, rated as 10/10 in severity. Peak intensity lasted for 10 min with resolution over the next 20. For the last 3 years, similar but milder headaches had rarely occurred with micturition. She did not use over-the-counter sympathomimetics, alcohol or illicit drugs. In the week prior, she noted escalation of her CC with headaches lasting hours instead of minutes. The headache leading to presentation was more severe and prolonged than previous coital headaches, but otherwise identical in character. Vital signs, including blood pressure were normal and there were no neurological deficits. Plain head computed tomography (CT) and lumbar puncture were normal.
展开▼
