Primary headache associated with sexual activity: case report

Primary Headache Associated with Sexual Activity: A Review of the Literature

PURPOSE OF REVIEW

This review summarizes the evolution in diagnosis, evaluation, and treatment of primary headache associated with sexual activity (PHASA).

RECENT FINDINGS

Despite increased access to patient information and advances in imaging, the pathophysiology of PHASA remains not fully understood. There are many secondary headaches that may present with headache during sexual activity, and a thorough workup is indicated to rule out potentially life-threatening etiologies. Many recent case series discuss the efficacy of known treatments of PHASA, as well as suggest other potential therapies for this condition including the newer CGRP-targeted therapies. Headaches during sexual activity can be worrisome events which necessitate urgent evaluation, particularly when presenting with sudden-onset and severe "thunderclap" headaches. A thorough workup including imaging should be conducted to rule out etiologies such as subarachnoid hemorrhage, reversible cerebral vasoconstrictive syndrome (RCVS), vasospasm, and dissection. PHASA is commonly comorbid with migraine, tension-type headache, exertional headache, and hypertension. PHASA can present as a dull headache that progresses with sexual excitement, or an explosive headache at or around orgasm. Pain is primarily occipital, diffuse, and bilateral. The headaches are discrete, recurrent events with bouts that typically self-resolve, but may also relapse and remit or continue chronically in some patients. PHASA can be treated preemptively with indomethacin and triptans administered prior to sexual activity, or treated prophylactically with beta-blockers, topiramate, and calcium channel blockers. CGRP-targeted therapies may provide relief in PHASA based on a few case reports, but there are no randomized controlled trials looking at specific efficacy for these therapies.

Successful treatment of primary headache associated with sexual activity using erenumab: Case report

BACKGROUND

Primary headache associated with sexual activity is a rare benign headache disorder that is provoked by sexual excitement. It is a diagnosis of exclusion after the underlying secondary causes have been ruled out. The cause of this headache disorder is still unknown. Cerebral vasospasm, pericranial muscular contraction, hemodynamic and respiratory changes during sexual activity are most commonly listed as possible pathophysiological mechanisms. Several acute and prophylactic options with good clinical response have been described in the case series.

CASE REPORT

We present a case of a 30-year-old woman with primary headache associated with sexual activity and comorbid with frequent episodic migraine without aura. Both headache disorders were successfully managed with monoclonal antibody against calcitonine gene-related peptide (CGRP) receptor erenumab 70 mg.

CONCLUSION

The efficacy of erenumab in our case presumes that CGRP might also be an important mediator in facilitating primary headache associated with sexual activity.

“To sleep”, “to cough” and “to love’: Uncommon primary headaches

IntroductionThere are some physiological situations in which the individual may experience headache, such as to sleep, to cough and to love. In the first situation, "to sleep", the patient does not have headache when awake, but is awakened by pain during sleep; in the second, the act of "to cough" is a trigger for the onset of pain and finally, "to love," here, meaning sexual intercourse, can be a headache trigger.ObjectiveTo review the epidemiological, pathophysiological aspects and therapeutic management of headaches that arise when sleeping, coughing and having sexual intercourse.MethodA narrative review of literature including case reports and clinical trials were carried out. The articles were systematically obtained and assessed by the authors.ResultsThree primary forms considered rare were identified: hypnic headache, primary cough headache and primary headache associated with sexual activity. Hypnic headache occurs only during sleep, predominantly in women after 50 years of age. It was described in 1988 by Raskin, and has a prevalence ranging from 0.07% to 0.22%. Primary cough headache is triggered by coughing or another Valsalva maneuver and is more common in men over40 years of age. It was first described by Jules Tinel and has a prevalence of 0.4% to 1.2%. Primary headache associated with sexual activity occurs during sexual intercourse. It is more frequent in men after 40 years of age. It was described in the second century of the Christian era, by the Persian physician Avicenna. Its prevalence ranges from 0.9% to 1.6%.ConclusionPrimary headaches in the "to sleep", "to cough", and "to love" group are rare. They predominate in men, after 40 years of age, are of short duration, can be primary or secondary and have a therapeutic response to indomethacin.

Headache Associated with Sexual Activity-A Narrative Review of Literature

Headache associated with sexual activity (HAWSA) has accompanied humanity since ancient times. However, it is only since the 1970s that it has become the subject of more extensive and detailed scientific interest. The purpose of this review is to provide an overview of the development of the concept of HAWSA, its clinical presentation, etiopathogenesis, diagnosis and treatment especially from the research perspective of the last 20 years. Primary HAWSA is a benign condition, whose etiology is unknown; however, at the first occurrence of headache associated with sexual activity, it is necessary to exclude conditions that are usually immediately life-threatening. Migraine, hypnic headache or hemicrania continua have been reported to co-occur with HAWSA, but their common pathophysiologic basis is still unknown. Recent advances in the treatment of HAWSA include the introduction of topiramate, progesterone, and treatments such as greater occipital nerve injection, arterial embolization, and manual therapy. Whether these new therapeutic options will stand the test of time remains to be seen.

Primary headache associated with sexual activity: A case series of 13 patients

Primary headache associated with sexual activity is an infrequent kind of headache mostly seen in the male gender and initiates during the third decade. Although the pathophysiology is still unknown, it is a benign type of headache and must be reminded of the differential diagnosis of the secondary headache. Thirteen patients were diagnosed and assessed by their clinical and demographic data. The mean age was 37.07 ± 7.67. Headache was usually localized at the bilateral occipital area or diffuse, starting with a severe ache and sudden explosive intensity in association with pre orgasm in eight patients and orgasm in five patients with a mean VAS score of 7.8 ± 1.2. The mean duration was 21.53 ± 15.32 min. Five patients had a history of migraine, three had arterial hypertension, and two were diagnosed as primary thunderclap headache with sudden beginning and high-intensity ache. Herein, we present our cases to highlight the importance of differential diagnosis. Patients may have difficulty explaining the problem; therefore, their sexual activity could be limited. Apart from pharmacological prevention, counseling plays an essential role in managing.