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

Deb Kumar Mojumder; Temesgen  Shibre; Babar Shahzad

doi:10.12746/swjm.v14i61.1680

Deb Kumar Mojumder Department of Neurocritical Care, Ochsner Medical Center, New Orleans, LA
Temesgen Shibre Department of Internal Medicine, Marshfield Medical Center, Marshfield, WI
Babar Shahzad Department of Internal Medicine, Marshfield Medical Center, Marshfield, WI

DOI: https://doi.org/10.12746/swjm.v14i61.1680

Abstract

A 46‑year‑old man with no prior headache history developed explosive orgasmic headaches six days after starting the Ayurvedic supplement Shilajit. The pain was of instantaneous maximal intensity (10/10), interrupted ejaculation, and later recurred with mild Valsalva‑like exertion. Neuroimaging (CT, CTA, MRI) was negative for hemorrhage or vasoconstriction. Lumbar puncture excluded subarachnoid hemorrhage. Due to low‑normal blood pressure (110/70 mmHg), calcium channel blockers were not used. He underwent a transnasal sphenopalatine ganglion block combined with bilateral greater occipital, lesser occipital, and supraorbital nerve blocks. His headache resolved immediately, and he resumed sexual activity without recurrence within 48 hours. This is the first report linking Shilajit to a probable reversible cerebral vasoconstriction syndrome (RCVS)-like presentation. Combined autonomic and sensory nerve blocks provided rapid headache control when standard vasodilators were contraindicated.

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References

1. Singhal AB, Hajj-Ali RA, Topcuoglu MA, et al. Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol. 2011;68(8):1005-1012.
2. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
3. Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet Neurol. 2012;11(10):906-917.
4. Tolba R, Weiss AL, Denis DJ. Sphenopalatine ganglion block: a review. Ochsner J. 2019;19(1):32-37.
5. Cvetanovich GL, Juthani RG, Mack WJ, Zampolin RL. Reversible cerebral vasoconstriction syndrome in a patient taking Hydroxycut. J Med Case Rep. 2011;5:548.
6. Lapid D, Abbasi A, Ramakrishnan N, Al-Shekhlee A. Possible reversible cerebral vasoconstriction syndrome associated with eucalyptus. J Vasc Interv Neurol. 2017;9(5):17-20.