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Coital Headache

Sexual Headache


Presentation

  • OBJECTIVE: To present a case of orgasmic headache caused by a basilar artery dissection and to present a literature-based guide to the diagnosis and management of patients presenting with headaches related to sexual activity.[read.qxmd.com]
  • OBJECTIVE: We describe a case of RCVS presenting as coital thunderclap headache with initial imaging demonstrating intraparenchymal hemorrhage and sulcal subarachnoid blood CASE: A 49-year-old Caucasian woman presented to her PCP with a three-day history[n.neurology.org]
  • […] of presenting headaches.[patient.info]
  • Abstract We studied the natural history of patients with a diagnosis of benign coital headache who presented to a private neurological clinic between the years 1978 and 1991.[onlinelibrary.wiley.com]
  • When patients first present with coital or orgasmic headache, it is mandatory to exclude serious underlying condition like ruptured aneurysm and bleeding in the brain.[nbharwani.com]
Turkish
  • Features of stabbing, cough, exertional, and sexual headaches in a Turkish population of headache patients. J Clin Neurosci. 2008; 15 :774–777. [ PubMed ] [ Google Scholar ] 3. Chakravarty A.[ncbi.nlm.nih.gov]
Dyspepsia
  • […] qualifying primary HAS as an example of indomethacin responsive headache alongside primary cough and primary stabbing headache). [26] A dose of 25-50 mg before or after intercourse prevents or reduce the duration of HAS. [26] A background history of dyspepsia[smjonline.org]
Ulcer
  • HAS as an example of indomethacin responsive headache alongside primary cough and primary stabbing headache). [26] A dose of 25-50 mg before or after intercourse prevents or reduce the duration of HAS. [26] A background history of dyspepsia or peptic ulcer[smjonline.org]
Cesarean Section
  • Laviola S, Kirvela M, Spoto MR, Tschuor S, Alon E: Pneumocephalus with intense headache and unilateral pupillary dilatation after accidental dural puncture during epidural anesthesia for cesarean section. Anesth Analg 1999, 88: 582–583. 199.[thejournalofheadacheandpain.biomedcentral.com]

Workup

  • Age and male sex positively correlated with radiological imaging workup (p table 2 ).[journals.plos.org]
  • The 2011 Scientific Statement from the AHA/ASA includes an algorithm for workup of suspected CVST.[reliasmedia.com]
  • […] decreased level of consciousness, a stiff neck, hemiparesis or hemisensory symptoms, visual changes, a seizure, or severe pain for more than 24 hours are not the features of primary headache associated with sexual activity and require immediate diagnostic workup[doctormigraine.com]

Treatment

  • “Headache associated with sexual activity: prognosis and treatment options.” Cephalalgia, 2007, 27, 1265–1270[americanmigrainefoundation.org]
  • Fortunately, treatment to prevent a recurrence of benign sexual headaches is both simple and effective.[wkhs.com]
  • For this patient, prophylactic treatment with beta-blockers and/or preemptive therapy with indomethacin was successful.[ncbi.nlm.nih.gov]
  • Pre-emptive treatment Propanolol hydrochloride ( Inderal) is effective in the prophylaxis of HSA [19].[bjmp.org]
  • Sexual headaches: Case report, review, and treatment with calcium blocker. Headache 1991;31:141-5.[smjonline.org]

Prognosis

  • Primary HAS has an excellent prognosis.[smjonline.org]
  • Even in those with chronic courses, 69% of these patients reached remission over the course of 3 years. 3 Therefore, sexual headaches typically have a favorable prognosis.[sexinfo.soc.ucsb.edu]
  • Prognosis Prognosis is usually good for HSA as it is a benign self- limiting disorder and disappears without any specific treatment in the majority of patients [17].[bjmp.org]
  • “Headache associated with sexual activity: prognosis and treatment options.” Cephalalgia, 2007, 27, 1265–1270[americanmigrainefoundation.org]
  • Fortunately, the prognosis is good and in the majority of patients where no underlying pathology is identified. With time the headaches disappear without any specific treatment.[nbharwani.com]

Etiology

  • Lack of angiographic evidence early in the course of recurrent headache in the presence of both intraparenchymal and sulcal subarachnoid blood should prompt vigilance as RCVS may be a potential etiology.[n.neurology.org]
  • Question What is the likely etiology of recent onset of coital headaches in an otherwise healthy 42-year-old man? Headaches begin at orgasm, are extremely intense, and localized near the top/center of the head.[medscape.com]
  • Minor leak before rupture of an intracranial aneurysm and subarachnoid hemorrhage of unknown etiology. Neurosurgery 1992 ;30: 7 – 11 Google Scholar Crossref Medline ISI 7. Leblanc, R. The minor leak preceding subarachnoid hemorrhage.[journals.sagepub.com]
  • External links Edit Medscape: Etiology of Coital Headaches Dexter, S. (2010). "Benign coital headache relieved by partner's pregnancies with implications for future treatment". Case Reports. 2010 : bcr1020092359. doi : 10.1136/bcr.10.2009.2359.[en.m.wikipedia.org]
  • External links [ edit ] Medscape: Etiology of Coital Headaches Dexter, S. (2010). "Benign coital headache relieved by partner's pregnancies with implications for future treatment". Case Reports. 2010 : bcr1020092359. doi : 10.1136/bcr.10.2009.2359.[en.wikipedia.org]

Epidemiology

  • Epidemiological research has further shown that 4.3 Primary headache associated with sexual activity can occur at any sexually active age, is more prevalent in males than in females (ratios range from 1.2:1 to 3:1), occurs independently of the type of[ichd-3.org]
  • […] headaches. [1] [5] Propranolol, Bellergal, and triptans have also been used with success. [1] Anecdotal and indirect evidence suggests a trial of magnesium supplementation may improve symptoms (in subjects with known or suspected low Mg levels). [6] Epidemiology[en.m.wikipedia.org]
  • This is generally benign and self-limiting but clearly requires investigation. [ 9 ] Epidemiology Little is known about the incidence but studies of neurological patients presenting with headache in France and Denmark have quoted figures of up to 1.3%[patient.info]
  • We report 2 new adolescent cases and review the semiology, epidemiology, and treatment of primary sex headache. KEY WORDS migraine primary sex headache adolescent sexual development Accepted February 29, 2012.[pediatrics.aappublications.org]
Sex distribution
Age distribution

Pathophysiology

  • Notes (2): the pathophysiology of TCH in the absence of underlying pathology is not well understood primary TCH has a distinctive clinical and angiographic profile and must be distinguished from central nervous system vasculitis and SAH Reference: BMJ[gpnotebook.co.uk]
  • CONCLUSIONS: RCVS remains a rare and difficult entity to treat; in part because the underlying pathophysiology is poorly understood.[n.neurology.org]
  • The exact pathophysiology of primary HAS is not completely understood, it is however believed that there is both a vascular and a muscular basis for the headache. [17] Local cerebral vasospasm in the concept of Reversible Cerebral Vasoconstriction Syndrome[smjonline.org]
  • Factors related to the pathophysiology of sex-related headaches are mainly a trigeminovascular effect, but there is a definite muscular component and impaired cerebrovascular autoregulation [ 1 ].[ncbi.nlm.nih.gov]
  • December 2005: Ginekologia Polska # 13 REVIEW Marcelo M Valença, Luciana P A A Valença, Carlos A Bordini, Wilson Farias da Silva, João P Leite, José Antunes-Rodrigues, José G Speciali BACKGROUND: The pathophysiology of the explosive type of headache associated[read.qxmd.com]

Prevention

  • (40-200 mg total per day) and diltiazem (60 mg 3 times daily) [12] can be given as a daily preventive if this headache type occurs frequently.[medscape.com]
  • Prevention Options Analgesics, such as ibuprofen or acetaminophen, have little effect once the headache begins. Fortunately, treatment to prevent a recurrence of benign sexual headaches is both simple and effective.[wkhs.com]
  • It may be prevented by postponing orgasm. It is the most common type of headache associated with sexual activity.[patient.info]
  • But if there is a pattern of sex headaches and no underlying cause, doctors may prescribe medication to prevent them. Reader Interactions[issm.info]

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