Shilajit-associated orgasmic thunderclap headache: A probable case of reversible cerebral vasoconstriction syndrome managed with nerve blocks

ABSTRACT

A 46-year-old man with no prior history of headache presented with explosive orgasmic headaches that began six days after initiating the Ayurvedic supplement Shilajit. The headaches were of sudden onset and maximal intensity (10/10), interrupted ejaculation, and subsequently recurred with mild Valsalva-like exertion. Neuroimaging, including CT, CTA, and MRI, was negative for intracranial hemorrhage or evidence of cerebral vasoconstriction. Lumbar puncture findings excluded subarachnoid hemorrhage. Given the patient’s low-normal blood pressure (110/70 mmHg), calcium channel blockers were not initiated.

He underwent a transnasal sphenopalatine ganglion block in combination with bilateral greater occipital, lesser occipital, and supraorbital nerve blocks. This resulted in immediate resolution of his headache, and he resumed sexual activity without recurrence of symptoms within 48 hours.

To our knowledge, this is the first reported case of a probable reversible cerebral vasoconstriction syndrome (RCVS)-like presentation associated with Shilajit use. Combined autonomic and sensory nerve blocks provided rapid and sustained headache relief when standard vasodilator therapy was contraindicated.

Keywords: Reversible cerebral vasoconstriction syndrome, thunderclap headache, Shilajit, nerve block, sphenopalatine ganglion, sexual activity