Thunderclap Headache

by Trevor
(Pacifica, California, USA)

Hello,
I recently had a frightening "thunderclap headache" occur at the exact moment I had an orgasm. It originated at the base of my skull but has moved up the left side and mainly presents pain behind my eye/eyes. I went to an ER and had a CT-Scan done and also a lumbar puncture which both came back normal......I was discharged as having a possible "post-coital headache" and an unspecified headache.

That was 10 days ago. Since then I have continued to have migraine type pain mainly on the left side but sometimes both. The pain level has fluctuated up and down during this period and for the most part I am not taking pain killers but occasionally take Tylenol when it is bad.

I went back to the ER yesterday as I was beginning to panic not only due to the continued pain but also because I have been having mild neurological symptoms. I feel distant/dull and I also seem to be hyper-sensitive to light as things just look a little different with my eyes either open or closed.....contrasted colors seem more vibrant or hazy.....

I had a few physical and sensory tests done by the doctor and she reviewed my previous tests and said I have a migraine and prescribed 10 mg. propranolol which does seem to be helping.

Ahhh....after all that, here is my simple question:

Does it seem reasonable that a migraine could produce these neurological symptoms for such a long time? The pain seems to be subsiding with the medication but I still feel "off" and my head feels full.

I have never had such problems before and it has been a bit frightening to say the least. I was trying to push for an MRI but the ER doctor did not think it was warranted.

Thank you for any advice or similar stories. I realize this is no place for a diagnosis but perhaps this sounds similar to other cases.....

Sincerely,
Trevor

Answer:

Hi Trevor,

Well coincidentally we saw a case today very similar to yours. CT of the head done in the ER for a headache after sex that was severe and disabling. In this case it was a woman.

One thing some doctors miss with this type of case is that rarely this type of headache can be associated with an aneurysm. Aneurysms are not too well seen on CT, but can be caught on an MRI of the brain and even better....an MRA. This looks just at the arteries.

You do not mention your age or if you smoke. Risk of aneurysm increases with a positive family history of aneurysm, hypertension and smoking.

You sound like you are in status migrainosus which is a migraine that has gone beyond 3 days. This could account for your continuing symptoms. A little propranolol and tylenol is not sufficient.

I would recommend that you try to get to a neurologist or your primary care soon to have a further work up. A short course of steroid (1-2 weeks low dose) or other medications may break the headache for you.

You should not take any migraine medication such as imitrex or other migraine meds until an aneurysm is ruled out.

If at the end of everything you do have post-coital headache,(also known as headache during sex) this is easily treated by taking naprosyn before sexual relations.

Good luck!
Mary Kay Betz MS RPA-C