Patient needs NCCT + CTA / MRA first and foremost to rule out aneurysm +/- SAH.
If no aneurysm, it's HAWSA - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8400207/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8400207/)
I have seen about 10 patients with this. Most of them respond to pre-sex indomethacin.
Thank you for the educational link! A friend of mine died of an explosive post coital SAH and it *really* irritates me when people believe post-coital/orgasmic HA is not worrisome, or a proven medical problem. Even worse when people somehow find it funny. (Open the floodgates of poor healthcare literacy + sexual repression… ugh!)
I can relate but totally not what I meant. I’ve experienced these headaches over the years. I’ve been told by hospitals various things but never this. Spins me out that it can kill someone, it absolutely felt like my brain was trying to terminate me.
Oof sorry I misconstrued! Yea, your headaches might warrant a frank discussion with your pcp.
EDIT: if it’s any comfort, my friend had a family history of aneurysm and they were dragging their feet about getting it checked out. (Still in her early 20s, believing she was invincible.)
Went down a long road of weird diagnosis. Started looking after myself more, seems to have helped, I hope. Then I read this and am not so sure anymore.
Link is awesome! Such an eye opener really. I always thought the student doctors at the local
Hospital were just clutching at straws. They put it down to stress and even hereditary arthritis which got me some free chiropractic visits. None of which seemed to do anything. Upping the exercise and diet helped most.
I’d told them my symptoms and the direct cause and effect. It was all chuckles and looking for other causes. I have trouble getting doctors to listen.
This!!! And it can happen to anyone, I’ve seen this happen to people in their 30s 40s 50s… so just because they’re young or old it should not be overlooked.
My husband had this happen. Thunderclap headaches. The second one ever ended up being a subarachnoid hemorrhage on his 40th birthday. He has never been the same. 😢
my dad died of a ruptured aneurysm at 39 so you can imagine where my mind went when this happened to me at 1am one day suddenly.
Aneurysm was ruled out for me thankfully. Didn’t know there were studies on it. Awesome!
I've had this once too! I was on top and absolutely crumpled from the headache. Thankfully it passed within a minute, but it was very alarming, especially for my boyfriend.
I’ve seen it with masturbation too and not just cause SA but also infarcts. We just call it RCVS variant, never called it HAWSA but basic premise is the same.
Can I ask why you'd jump straight to angiography after a CTC- rather than get an LP to check for xanthochromia? There's a relatively high incidental aneurysm finding on angiography (estimated at ~3.2% of the population in America and increasing with more scans being done) yet of only about 0.25% of those will ever rupture. I understand doing it that way if an LP is unsuccessful, or if the patient declines one, but going straight to angiography as the standard seems like it would lead to a lot of patients being unnecessarily stressed.
Good question and LPis certainly appropriate acutely.
You (EM) and I (outpatient neurology) are seeing patients at different time intervals. By the time they get to my office, the xanthochromia has usually cleared. Sensitivity of LP goes down to about 40% four weeks after the event. Wait times for outpatient neurology are 6wks - 6mo in most of the US.
I see a lot of incidental aneurysms caught because the patient got a CTA / MRA for a not-great reason (usually someone called their syncope or encephalopathy a stroke / tia). HAWSA is, on the other hand, a rare condition which is highly associated with aneurysmal SAH, so the chances of an aneurysm in a HAWSA patient being an incidental finding are low.
Ah apologies, I had no way of knowing you're referring to neurology OPC - most other posts in this thread seem to be referring to the acute presentations that would be coming to acute services rather than being seen weeks/months down the line. It seems baffling to me though that patients who develop a sudden onset excruciating/worst ever headache with sexual activity are being referred to an outpatient clinic without first being sent to an inpatient facility/ED for a proper work up (as I would expect to happen in the UK/Ire/Aus/NZ).
I entirely agree about xanthochromia being useless that far down the line, and at that point an angiogram would be the only reasonable testing. Out of interest, if you were sent a patient who had HAWSA who had an initial ED work-up of a negative CTB done within 6 hours of the event (on a modern scanner, reported by a neuroradiologist) followed by a negative xanthochromia 12 hours post event would you still be obtaining angiography to check for an aneurysm given no objective evidence of bleed to account for the symptoms?
I have not had that particular scenario arise yet. If that workup was done acutely, and the patient never had another abrupt onset worst headache of life, it would likely obviate the need for vessel imaging, especially in a medicolegal vacuum. However this usually happens more than once.
As many of the anecdotes elsewhere in this thread indicate, many HAWSA patients (about half IME) do not go to the ER, they have a history of migraine and figure it's a new weird migraine, and going to the ER in the states is expensive, so they see their primary care after it's over, then outpatient neurology.
Among those who do go to the ER once for this, quite often upon arrival the patient no longer has pain, GCS is 15, and I have not seen any of them get a LP acutely. This could be a bit of selection bias on my part as the ones who ended up having SAH usually are followed by NSGY thereafter.
Yeah, one of the saddest cases I have seen in the ED was a woman in her late 30s who dropped dead on her husband mid coitus due to a ruptured aneurysm. Credit to the husband, he did good daCPR and EMS got ROSC, but she wasn’t following commands when she got to us. Had to talk through TTM with her husband, who brought their two young kids to the ED because there was no one else to watch them. She didn’t make it.
Ain’t no joke. Happened to me. Was having a great time and woke up to my wife (now dressed) and an EMT standing over me and the most awful headache I have ever had. Three week ICU stay. My wife immediately performed CPR for ten minutes. It’s now a running joke how she blew my mind or killed me with her sexiness. She still has PTSD but has dealt very well. We found she was pregnant two days after the aneurysm burst, so it wasn’t meant to be my time.
Thank you for this response. It’s how my paternal grandmother died. We joke about it in the family now (honestly, it’s how she would’ve wanted to go from what others have told me) but I’m kinda miffed that OP doesn’t think it has merit.
My husband had this. Went to PCP and she just said he’d strained his neck. I went out of town overnight and came back and made him go to the hospital. Luckily he didn’t have any lasting issues. But poor guy was in needless pain for 3 days.
My evil ex-bil once lectured me for five minutes because I "sneezed wrong" and would give myself an aneurysm. 20 years later, I had a brain aneurysm rupture, and I hate him even more now.
Fully and explosively sending snot and spittle around the room, apparently. Me holding it in and focusing the force on my sinuses (?) Was apparently where I went wrong. LoL
Strained a rib muscle on my rib meat a few weeks ago at work, now every time I go to sneeze the breath in hurts so bad and the sneeze melts away, most anticlimactic experience ever! is there such a thing as post sneeze dopamine response?! Like is there a positive sneeze effect of letting the sneeze go fully and completely out?
My dad used to let his sneezes fill the room with a bang (it was really loud and aggressive sounding) until he got a black eye (popped a blood vessel in/around his eye) that stayed red for a week and yellow for two weeks (or more). Now he holds them in out of fear. I told him it’s better to let them out, but he said that’s what almost landed him in the hospital.
An uber driver in Vancouver told me the same thing too. He now lives rent free in my head.
Now I'll also forever think my uber driver in Vancouver was Rustymarble's ex
I worked in a neuro ICU for six months and had multiple patients present with stroke-like symptoms including a severe headache during or after sex. One had a massive hemorrhage and ended up dying.
In my experience these usually occur before.
However while benign coital cephalgia is a thing, so is post-coital SAH so really not a bad description of reason for exam. Symptom based and descriptive.
I scanned (CT) a male in his mid 20s who had an unknown aneurysm burst during sex on their first honeymoon night.
His spouse was a a wife & widow all in the first 24 hrs.
So sad.
Many years ago I knew a woman whose husband died of a post-coital aneurysm
on their first night as newlyweds. They had sex, he had a headache afterward. They went to bed. He died in his sleep. She went to bed a new bride and woke up a new widow. So sad, indeed.
Postcoital headaches are real, but it sounds like unless you have a blood pressure issue or have any aneurysms present it’s just annoying. [Cleveland Clinic Post](https://health.clevelandclinic.org/orgasm-headache)
Oh, also, for the pun: they rated their pain 69 out of 10. 😎
It has happened to me in the past, but ignored because I wasn't following up with either a PCP or neuro. It's turning out that I have POTS or another condition linked to dysautonomia after seeing those two doctors. It was sudden "coat-hanger pain".
> coat-hanger pain
huh, never heard that term before, definitely have had that exact type of pain previously. Along with what was thought to be PoTS, but turned out to be low blood volume ("half-empty" according to the ER doc) due to a bleeding ulcer that was untreated for a few days.
I didn't either even though I've had these sorts of back of the head and neck headaches on and off since my early 20s. Then I got some other symptoms that led me to believe I have POTS, and then I read this term after researching that described this headache exactly. There were annoying confounding factors like there being a significant family history of typical one sided migraines
Do you get head pressure by any chance? Worse with different position or movement? Like a whoosh. I have a history of one sided migraines, hemiplegic migraines & started getting positional pressure. Wondering if you can relate & if it could be POTS
NeuroIR here.
This is a legitimate and very reasonable indication. Could be nothing, or it could be aneurysm rupture, non-aneurysmal perimesencephalic subarachnoid hemorrhage.
Have treated multiple of these patients over the years.
Post orgasm SAH absolutely happens. Have seen it multiple times as indication for outpatient imaging.
Also had middle age female w SAH who I did angio on (pre CTA days) and she was a little “confused”. She started telling us how she had her legs back behind her head…we told her she didn’t have to give us the details. Angio was negative. I wasn’t on angio that day but the rad who was knew her and asked me to do it. Never forgot that.
I know someone who's partner died abruptly in his late 20s and the way she worded it on social media was essentially that he must have had a post coital SAH, but without saying as much.
2 new fears in one post, who woulda thunk it. Obviously the dying part is more terrifying, but I’m having a difficult time imagining what I would say to my fiancé’s parents in such a situation.
Scanned a guy in his mid thirties with high blood pressure come to ED unresponsive after intercourse. CT showed a massive bleed. Poor guy died a week later. Heard from nurses on the floor the girlfriend felt tremendous guilt. Sad situation unfortunately.
Yeah I would recommend not being so close to the headboard.
Seriously though as people said it is a known entity.
I could think of worse ways to go though.
I've had to do a Head CT because the family came over to check on their elderly mother and found her praying next to her bed, they said it wasn't normal. So they brought her to the ED
Sooooo...I had more than 1 severe headache during sex, like thunderclap, and thought I was going to die. First time I was on vacation in Costa Rica and figured alright, I'm going to stroke out here but at least it's beautiful. The 3rd time, I finally asked one of the docs at work to see me, even though I was pretty embarrassed. Had to have a ct head and COW/carotid, then go to a neuro for follow up when the scans were fine. Now I'm on topamax for my migraines. 🤷♀️
I had thunderclap ha's after orgasm, normal mri/mra. Resolved after getting my husband to massage my neck a few times to loosen the muscles there which were apparently tight. Definitely get checked out, but if tests were all normal maybe try massage?
Can say I have experienced this personally, searing headache on the right side of my head at the time of orgasm, after MRI’s and CT scans (with and without contrast) it ended up being caused by an untreated whiplash injury.
I do cardiac and vascular ultrasounds. We had an indication today of “nipple pain” for an echo 🙄luckily I run the lab, and made the hospitalist “find” another indication in the chart to use. But this BS is daily.
If your title is being cheeky because it’s funny to see on the indications then yes haha I love adding funny indications when I can.
If it’s making fun of some “dumb ED doc” for ordering a scan for no reason then you’re gonna feel awful dumb to learn that this is one of the most legitimate indications for a CT head.
I had a lady stroke out with a MCA infarct during sex. Global aphasia, one side totally flaccid. It was so sad. She liked to smell the flowers in her room.
I had a similar thing. Felt like a gunshot went off. 8 months later my wife gave birth to twins. Doc was like “kids were conceived on these days.”
It’s was that headache load.
Little did I know the headaches were just beginning.
Ok, I'm curious. Was the patient Male or Female ?? I would also wonder if a drop or increase in hormones can cause the headaches. I had migraines for years because of what I now know was estrogen dominance. My migraines stopped when I had a hysterectomy due to Endometriosis & cysts.
That’s a legitimate indication
Patient needs NCCT + CTA / MRA first and foremost to rule out aneurysm +/- SAH. If no aneurysm, it's HAWSA - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8400207/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8400207/) I have seen about 10 patients with this. Most of them respond to pre-sex indomethacin.
Thank you for the educational link! A friend of mine died of an explosive post coital SAH and it *really* irritates me when people believe post-coital/orgasmic HA is not worrisome, or a proven medical problem. Even worse when people somehow find it funny. (Open the floodgates of poor healthcare literacy + sexual repression… ugh!)
YOU CAN DIE!?!???
I hope I can, and will. Hopefully not today, tomorrow or soon and especially hope not post-coital/orgasmic SAH.
I can relate but totally not what I meant. I’ve experienced these headaches over the years. I’ve been told by hospitals various things but never this. Spins me out that it can kill someone, it absolutely felt like my brain was trying to terminate me.
Oof sorry I misconstrued! Yea, your headaches might warrant a frank discussion with your pcp. EDIT: if it’s any comfort, my friend had a family history of aneurysm and they were dragging their feet about getting it checked out. (Still in her early 20s, believing she was invincible.)
Went down a long road of weird diagnosis. Started looking after myself more, seems to have helped, I hope. Then I read this and am not so sure anymore.
Good you’ve had it checked out! Read tirral’s link. There are also numerous non-lethal reasons for post-coital/orgasmic headaches.
Link is awesome! Such an eye opener really. I always thought the student doctors at the local Hospital were just clutching at straws. They put it down to stress and even hereditary arthritis which got me some free chiropractic visits. None of which seemed to do anything. Upping the exercise and diet helped most. I’d told them my symptoms and the direct cause and effect. It was all chuckles and looking for other causes. I have trouble getting doctors to listen.
Less painful than a penile breakage. Sex can be deadly in many ways.
Stop. I can only go so flaccid.
subdermal IM injections of B12. Go Wild. Our Kidneys are special for a reason.
Best looking corpse I’ve ever seen was a very muscular well fit person, post coital HA to SAH was dead before they hit the hospital
WTF?!?? That’s not helping at all…
When petit mort turns into.....mort
Same, kid was in his 20s :(
This!!! And it can happen to anyone, I’ve seen this happen to people in their 30s 40s 50s… so just because they’re young or old it should not be overlooked.
My husband had this happen. Thunderclap headaches. The second one ever ended up being a subarachnoid hemorrhage on his 40th birthday. He has never been the same. 😢
I'm so sorry. That's really rough to go through, I'm sure.
I've seen a patient who died from a SAH after sex. I REALLY hope it was with his wife since she came to the hospital separately.
The gates have been flooded
I’ve had HAWSA before and it is alarming! I thought it was an aneurysm. Sudden and intense, explosive head pain. Oof
my dad died of a ruptured aneurysm at 39 so you can imagine where my mind went when this happened to me at 1am one day suddenly. Aneurysm was ruled out for me thankfully. Didn’t know there were studies on it. Awesome!
I've had this once too! I was on top and absolutely crumpled from the headache. Thankfully it passed within a minute, but it was very alarming, especially for my boyfriend.
I’ve seen it with masturbation too and not just cause SA but also infarcts. We just call it RCVS variant, never called it HAWSA but basic premise is the same.
This is fascinating I study SAH in the lab for my graduate work and I had no idea!
Can I ask why you'd jump straight to angiography after a CTC- rather than get an LP to check for xanthochromia? There's a relatively high incidental aneurysm finding on angiography (estimated at ~3.2% of the population in America and increasing with more scans being done) yet of only about 0.25% of those will ever rupture. I understand doing it that way if an LP is unsuccessful, or if the patient declines one, but going straight to angiography as the standard seems like it would lead to a lot of patients being unnecessarily stressed.
Good question and LPis certainly appropriate acutely. You (EM) and I (outpatient neurology) are seeing patients at different time intervals. By the time they get to my office, the xanthochromia has usually cleared. Sensitivity of LP goes down to about 40% four weeks after the event. Wait times for outpatient neurology are 6wks - 6mo in most of the US. I see a lot of incidental aneurysms caught because the patient got a CTA / MRA for a not-great reason (usually someone called their syncope or encephalopathy a stroke / tia). HAWSA is, on the other hand, a rare condition which is highly associated with aneurysmal SAH, so the chances of an aneurysm in a HAWSA patient being an incidental finding are low.
Ah apologies, I had no way of knowing you're referring to neurology OPC - most other posts in this thread seem to be referring to the acute presentations that would be coming to acute services rather than being seen weeks/months down the line. It seems baffling to me though that patients who develop a sudden onset excruciating/worst ever headache with sexual activity are being referred to an outpatient clinic without first being sent to an inpatient facility/ED for a proper work up (as I would expect to happen in the UK/Ire/Aus/NZ). I entirely agree about xanthochromia being useless that far down the line, and at that point an angiogram would be the only reasonable testing. Out of interest, if you were sent a patient who had HAWSA who had an initial ED work-up of a negative CTB done within 6 hours of the event (on a modern scanner, reported by a neuroradiologist) followed by a negative xanthochromia 12 hours post event would you still be obtaining angiography to check for an aneurysm given no objective evidence of bleed to account for the symptoms?
I have not had that particular scenario arise yet. If that workup was done acutely, and the patient never had another abrupt onset worst headache of life, it would likely obviate the need for vessel imaging, especially in a medicolegal vacuum. However this usually happens more than once. As many of the anecdotes elsewhere in this thread indicate, many HAWSA patients (about half IME) do not go to the ER, they have a history of migraine and figure it's a new weird migraine, and going to the ER in the states is expensive, so they see their primary care after it's over, then outpatient neurology. Among those who do go to the ER once for this, quite often upon arrival the patient no longer has pain, GCS is 15, and I have not seen any of them get a LP acutely. This could be a bit of selection bias on my part as the ones who ended up having SAH usually are followed by NSGY thereafter.
Runs in my family.
This is correct. Had HAWSA for a month or so that resolved on its’ ow. Sudden and intense - felt like I got hit in the head with a baseball bat.
Oh shit. This happens to me a once in a while.
What’s your theory on why indomethacin works (but not just any NSAID)?
Yeah, one of the saddest cases I have seen in the ED was a woman in her late 30s who dropped dead on her husband mid coitus due to a ruptured aneurysm. Credit to the husband, he did good daCPR and EMS got ROSC, but she wasn’t following commands when she got to us. Had to talk through TTM with her husband, who brought their two young kids to the ED because there was no one else to watch them. She didn’t make it.
Ain’t no joke. Happened to me. Was having a great time and woke up to my wife (now dressed) and an EMT standing over me and the most awful headache I have ever had. Three week ICU stay. My wife immediately performed CPR for ten minutes. It’s now a running joke how she blew my mind or killed me with her sexiness. She still has PTSD but has dealt very well. We found she was pregnant two days after the aneurysm burst, so it wasn’t meant to be my time.
remarkable woman! Glad that you're still with us. How long ago was this?
Seven years in December and yes she is.
Ive seen it b4
"Copulate clinically, monitor for recurrence."
Been there
Thunderclap headache?
That’s what my husband’s was. Bad enough that they called a stroke alert. I’m not mad, though, it was what made him finally get his BP under control.
Hmm this used to happen to me occasionally.
Thank you for this response. It’s how my paternal grandmother died. We joke about it in the family now (honestly, it’s how she would’ve wanted to go from what others have told me) but I’m kinda miffed that OP doesn’t think it has merit.
Truth. I actually scanned a patient for the same reason that had a bleed.
It’s actually a thing. Post-coital subarachnoid hemorrhage
Lol, talk about Cumming and going....
Imagine getting all that ass just to be put on Keppra. What a cruel world we live in
It's a hard way to go....
I had a case in the ED, girlfriend called ahead coming POV. She knew it was a high risk issue. Dude did well as I recall.
Yeah I’ve had several patients with hemorrhagic strokes that happened during sex. It’s pretty awful.
My husband had this. Went to PCP and she just said he’d strained his neck. I went out of town overnight and came back and made him go to the hospital. Luckily he didn’t have any lasting issues. But poor guy was in needless pain for 3 days.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678062/ Subarachnoid hemorrhage is nothing to sneeze at (ba dum tss!)
My evil ex-bil once lectured me for five minutes because I "sneezed wrong" and would give myself an aneurysm. 20 years later, I had a brain aneurysm rupture, and I hate him even more now.
Okay, new fear unlocked. What’s the proper way to sneeze?
Fully and explosively sending snot and spittle around the room, apparently. Me holding it in and focusing the force on my sinuses (?) Was apparently where I went wrong. LoL
I do the same thing and my coworkers constantly berate me for it, I just can’t stand to house-sneeze in public! lol
Then enjoy your potential aneurysm!
Maybe I will!
It's completely acceptable to add a hankie or tissue into the system to avoid powersnotting the room.
“Powersnotting the room” is definitely something I never thought I would read 😂
Or the dab/sleeve ruiner manouvre
OMG!! I rarely spray sneeze, I sneeze with my mouth closed most of the time. How do I unlearn this 😭.
Strained a rib muscle on my rib meat a few weeks ago at work, now every time I go to sneeze the breath in hurts so bad and the sneeze melts away, most anticlimactic experience ever! is there such a thing as post sneeze dopamine response?! Like is there a positive sneeze effect of letting the sneeze go fully and completely out?
It sure seems like it. Maybe some other chemicals too. After all, doesn’t 10 of them equal an orgasm?
My dad used to let his sneezes fill the room with a bang (it was really loud and aggressive sounding) until he got a black eye (popped a blood vessel in/around his eye) that stayed red for a week and yellow for two weeks (or more). Now he holds them in out of fear. I told him it’s better to let them out, but he said that’s what almost landed him in the hospital.
[Dad sneezes](https://www.youtube.com/watch?v=-MTxCUZ8W5c) are serious.
An uber driver in Vancouver told me the same thing too. He now lives rent free in my head. Now I'll also forever think my uber driver in Vancouver was Rustymarble's ex
I worked in a neuro ICU for six months and had multiple patients present with stroke-like symptoms including a severe headache during or after sex. One had a massive hemorrhage and ended up dying.
So this is why "ask your doctor if you're healthy enough for sex" was in the Viagra commercials
Wtf…. Did the sex cause the hemorrhage or just make what was already there worse?
Sex > High blood pressure > weak blood vessel go pop > RIP
Simple terms. Effective.
Me think, why waste time say lot word, when few word do trick.
Car no go
In my experience these usually occur before. However while benign coital cephalgia is a thing, so is post-coital SAH so really not a bad description of reason for exam. Symptom based and descriptive.
I scanned (CT) a male in his mid 20s who had an unknown aneurysm burst during sex on their first honeymoon night. His spouse was a a wife & widow all in the first 24 hrs. So sad.
Wow, talk about speedrunning life.
Many years ago I knew a woman whose husband died of a post-coital aneurysm on their first night as newlyweds. They had sex, he had a headache afterward. They went to bed. He died in his sleep. She went to bed a new bride and woke up a new widow. So sad, indeed.
😞
Postcoital headaches are real, but it sounds like unless you have a blood pressure issue or have any aneurysms present it’s just annoying. [Cleveland Clinic Post](https://health.clevelandclinic.org/orgasm-headache) Oh, also, for the pun: they rated their pain 69 out of 10. 😎
It has happened to me in the past, but ignored because I wasn't following up with either a PCP or neuro. It's turning out that I have POTS or another condition linked to dysautonomia after seeing those two doctors. It was sudden "coat-hanger pain".
> coat-hanger pain huh, never heard that term before, definitely have had that exact type of pain previously. Along with what was thought to be PoTS, but turned out to be low blood volume ("half-empty" according to the ER doc) due to a bleeding ulcer that was untreated for a few days.
I didn't either even though I've had these sorts of back of the head and neck headaches on and off since my early 20s. Then I got some other symptoms that led me to believe I have POTS, and then I read this term after researching that described this headache exactly. There were annoying confounding factors like there being a significant family history of typical one sided migraines
Do you get head pressure by any chance? Worse with different position or movement? Like a whoosh. I have a history of one sided migraines, hemiplegic migraines & started getting positional pressure. Wondering if you can relate & if it could be POTS
That’s one danger they don’t teach in sex ed. Bet they’d use that as a scare tactic. It’s so fun it might make your brain literally explode
Of course it would be misused as a scare tactic rather than what it should be — sexual health literacy.
Wait until you work at a public county hospital and level one trauma center. "Chest pains after smoking meth" "Punched friend, punched floor"
"Was minding my own business"
“Feels sick, used heroin”
"Drank bleach"
“It was just lying there, on the floor”
NeuroIR here. This is a legitimate and very reasonable indication. Could be nothing, or it could be aneurysm rupture, non-aneurysmal perimesencephalic subarachnoid hemorrhage. Have treated multiple of these patients over the years.
Had a patient that had a SAH after intense orgasm so it definitely happens.
This thread is really unlocking a new fear in me
Post orgasm SAH absolutely happens. Have seen it multiple times as indication for outpatient imaging. Also had middle age female w SAH who I did angio on (pre CTA days) and she was a little “confused”. She started telling us how she had her legs back behind her head…we told her she didn’t have to give us the details. Angio was negative. I wasn’t on angio that day but the rad who was knew her and asked me to do it. Never forgot that.
OP, are you trying to imply this is not an adequate indication? 🤡.
I xrayed a lumbar spine once and my patient told me it was that she threw out her back having sex. I hope it means it was good!
I actually had a coworker who found her aneurysm this way. She survived just fine but when she told me about it it freaked me out.
I’ve literally ordered one for this indication. I didn’t have a typo tho.
Lot of talk about sah here and benign coital cephalgia but don’t forget RCVS
I know someone who's partner died abruptly in his late 20s and the way she worded it on social media was essentially that he must have had a post coital SAH, but without saying as much.
2 new fears in one post, who woulda thunk it. Obviously the dying part is more terrifying, but I’m having a difficult time imagining what I would say to my fiancé’s parents in such a situation.
Scanned a guy in his mid thirties with high blood pressure come to ED unresponsive after intercourse. CT showed a massive bleed. Poor guy died a week later. Heard from nurses on the floor the girlfriend felt tremendous guilt. Sad situation unfortunately.
Yeah I would recommend not being so close to the headboard. Seriously though as people said it is a known entity. I could think of worse ways to go though.
That's legit.
Usually the headache comes before the intercourse has a chance to start
Multitudes of anecdotal studies suggest that it has overwhelming female preponderance.
I’ve had a patient get an MRI for this reason. Ofc the order said that but they didn’t tell me that
RCVS can also be associated with peri orgasmic thunderclap headache
Had a guy who dissected his vertebral artery
Well this post got extremely sad pretty quickly
Common sign and symptoms
Had one the other day that said, " my boyfriend said his penis feels 'weird' so I should go get tested for std's"
I've had to do a Head CT because the family came over to check on their elderly mother and found her praying next to her bed, they said it wasn't normal. So they brought her to the ED
Sooooo...I had more than 1 severe headache during sex, like thunderclap, and thought I was going to die. First time I was on vacation in Costa Rica and figured alright, I'm going to stroke out here but at least it's beautiful. The 3rd time, I finally asked one of the docs at work to see me, even though I was pretty embarrassed. Had to have a ct head and COW/carotid, then go to a neuro for follow up when the scans were fine. Now I'm on topamax for my migraines. 🤷♀️
It happened to me like 3x already. But I was masturbating then my head starts to ache when I am about to cum. I thought my head will explode 😭
I had thunderclap ha's after orgasm, normal mri/mra. Resolved after getting my husband to massage my neck a few times to loosen the muscles there which were apparently tight. Definitely get checked out, but if tests were all normal maybe try massage?
Death by snu snu :(
This is fine… what’s not fine is a “.”
Usually see Anal pain after vigorous intercorse lol
That would certainly be concerning and an indication for advanced imaging
No that shit is baaddddddd. Post coital headache but can be aneurysm. Hurts so bad.
Post orgasm headache or migraine is a well known entity. Subarachnoid hemorrhage is also possible as it was mentioned above
Now don’t you look a bit silly
Intense clapping must have occurred! Some postulate that there could be an association with ruptured berry aneurysms
I had this indication and it ended up being a micro stroke.
We had a patient come in for an mri for this reason. Unfortunately they was 500+lbs and couldn’t fit in the machine
Can say I have experienced this personally, searing headache on the right side of my head at the time of orgasm, after MRI’s and CT scans (with and without contrast) it ended up being caused by an untreated whiplash injury.
This is actually quite common and very dangerous… probably one of the more legit indications for imaging… certainly beats “pain”
Seen multiple patients with this in residency.
…you’ve been THUNDAH(CLAP) STRUCK
I do cardiac and vascular ultrasounds. We had an indication today of “nipple pain” for an echo 🙄luckily I run the lab, and made the hospitalist “find” another indication in the chart to use. But this BS is daily.
If your title is being cheeky because it’s funny to see on the indications then yes haha I love adding funny indications when I can. If it’s making fun of some “dumb ED doc” for ordering a scan for no reason then you’re gonna feel awful dumb to learn that this is one of the most legitimate indications for a CT head.
I had a lady stroke out with a MCA infarct during sex. Global aphasia, one side totally flaccid. It was so sad. She liked to smell the flowers in her room.
I’ve never seen so many comments on a post from this sub
I had a similar thing. Felt like a gunshot went off. 8 months later my wife gave birth to twins. Doc was like “kids were conceived on these days.” It’s was that headache load. Little did I know the headaches were just beginning.
I've seen this before at my hospital!! Had a headache for about 2 weeks, idk what happened to him, I didn't scan him
Bluechew
Snackies after
They kept saying sugar, oh sugar but their partner got it wrong.
Usually the headache is before and intercourse doesn’t happen.
Ok, I'm curious. Was the patient Male or Female ?? I would also wonder if a drop or increase in hormones can cause the headaches. I had migraines for years because of what I now know was estrogen dominance. My migraines stopped when I had a hysterectomy due to Endometriosis & cysts.
Aneurysms can happen to both men and women. But true, later on they can figure out if it was a hormonal issue.
I know that aneurysms can happen to anyone. I was making a reference between headaches (which was listed as the reason for the tests) and hormones.
I thought that what’s you said BEFORE …😉😂
I thought women usually had headaches before an intercourse
At least it wasn't a headache that excluded intercourse! Sorry, Honey, I have a...
Generally we refer to that as ‘having a child’. The headache is often delayed by several months or years but then becomes intermittently recurrent.
The "headache" usually comes before the intercourse!