Presentation
[…] of presenting headaches. [patient.info]
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]
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]
It is intense, holocranial, throbbing and accompanied by a stiff neck (as you can see the clinical presentation may resemble that of a post coital headache). [braindiseases.blog]
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]
Entire Body System
- Pain
It is a sudden, intense pain near or at the moment of orgasm. The pain remains intense for 5-15 minutes, though some people report pain lasting as long as several hours or up to 2 days. [wkhs.com]
[…] in the head and neck Pain occurs only during sexual activity Pain intensifies abruptly and powerfully as sexual excitement increases and/or around the time of orgasm Pain lasts between one minute (minimum) and seventy-two hours (maximum) Pain is not [sexinfo.soc.ucsb.edu]
Headache: The Journal of Head and Face Pain. 36 (3): 154–160. doi : 10.1046/j.1526-4610.1996.3603154.x. External links [ edit ] Medscape: Etiology of Coital Headaches Dexter, S. (2010). [en.wikipedia.org]
“You can treat prophylactically [take pain medications prior to starting sexual activity], but if the headaches are infrequent and not too severe, waiting to medicate until first pain is a likely a better strategy to avoid rebound headaches in the future [sheknows.com]
Primary headache associated with sexual activity generally lasts from 1 minute to 24 hours with severe pain and up to 72 hours with mild pain. [americanmigrainefoundation.org]
- Falling
The headaches actually fall into two categories: pre-orgasm and post-orgasm. The former is a better tolerated pain that starts in the neck, jaw and head, and builds slowly. [globalnews.ca]
But here is what they do know: these headaches fall into three basic categories. It can occur before orgasm, immediately upon coming (a la my friend) or directly afterwards. The pain can be dull or the knife-like stabbing she described. [jezebel.com]
If you do not fall into the risk above you can safely take the combined pill up to the age of 50 and there is no reason to change. [independent.ie]
Even so, it was 3am and neither the worry nor the pain stopped me from falling asleep. The next morning, the pain was still there. It had dulled to an unpleasant throb. [theguardian.com]
Additionally, avoidance of drugs that may act as a trigger (such as marijuana, amyl nitrite, amphetamines, sildenafil and some anxiolytics) can be helpful in reducing the risk of sexual headaches. 7 Prognosis The course of this condition tends to fall [sexinfo.soc.ucsb.edu]
- Fever
Women's Health Cards Part 2 [PDF] Feeling generally unwell with flu-like symptoms such as fever, tiredness, headache, swollen glands, aches and pains in the lower back... [evidence.nhs.uk]
He denies having had any fever, neck stiffness, or changes in strength, coordination, speech, or vision and has no other complaints. He denies any past medical history or drug use. [neurologytimes.com]
You might also have several other symptoms, including: Changes in vision Confusion Nausea Numbness Vomiting Weakness Fever Seizures Causes Thunderclap headaches could be caused by bleeding from an artery into the space surrounding your brain. [webmd.com]
Whether or not you choose to take antimalarial tablets, the most important thing is to see a doctor urgently if you become unwell or develop a fever for up to a year after your trip. [independent.co.uk]
- Surgical Procedure
These may include medications to lower blood pressure and prevent seizures, medications to break up blood clots, or surgical procedures to fix abnormal blood vessels [7,8]. [buoyhealth.com]
Gastrointestinal
- Vomiting
In all but one patient, who had a transient blurred vision, the headache was not accompanied by nausea, vomiting, visual disturbances, sensory/motor disturbances, or unconsciousness. [onlinelibrary.wiley.com]
He states he rarely gets headaches, but has been having them on and off all week, all mild to moderate until tonight, when right after sexual intercourse, he experienced a sudden severe headache and vomited twice. [neurologytimes.com]
This form is more likely to be accompanied by nausea and vomiting. [verywellhealth.com]
It can cause intense pain and often nausea and vomiting. If you have one, get emergency medical attention. The cause, which can be life-threatening, is often some kind of bleeding in or around your brain. [webmd.com]
Notes: 4.3 Primary headache associated with sexual activity is not associated with disturbance of consciousness, vomiting or visual, sensory or motor symptoms, whereas symptomatic sexual headache may be. [ichd-3.org]
Musculoskeletal
- Neck Pain
Neck pain or stiffness: A sex headache that is caused by bleeding in the brain or a tear in the wall of a blood vessel in the brain or neck may be associated with neck pain or stiffness (meningismus). You may feel it is difficult to bend the neck. [buoyhealth.com]
[…] in the head and neck Pain occurs only during sexual activity Pain intensifies abruptly and powerfully as sexual excitement increases and/or around the time of orgasm Pain lasts between one minute (minimum) and seventy-two hours (maximum) Pain is not [sexinfo.soc.ucsb.edu]
Dissection patients will present most commonly with headache, neck pain, and facial pain. [reliasmedia.com]
Neurologic
- Headache
[…] for Benign coital headache and additional synonyms G44.82 Headache associated with sexual activity Synonyms: Benign coital headache|Benign coital headache (finding)|Headache associated with sexual activity (finding)|Orgasmic headache|Preorgasmic headache [averbis.com]
Let us discuss post-coital headache also at times referred to as orgasmic headache. What is post coital headache? The history is quite typical. This is a throbbing and at times intense headache which comes on at or near the height of orgasm. [braindiseases.blog]
[…] of the International Headache Society 2013 ; Headache Classification Committee of the International Headache Society 2018). [medlink.com]
[…] and orgasmic headache. [en.wikipedia.org]
Previously used terms: Benign sex headache; benign vascular sexual headache; coital cephalalgia; coital headache; intercourse headache; orgasmic cephalalgia; orgasmic headache; sexual headache. [ichd-3.org]
- Orgasmic Headache
The second type is a vascular headache. It is a very intense, severe headache usually occurring just before orgasm. It has been called an “orgasmic headache” or “orgasmic cephalalgia.” [headaches.org]
[…] for Benign coital headache and additional synonyms G44.82 Headache associated with sexual activity Synonyms: Benign coital headache|Benign coital headache (finding)|Headache associated with sexual activity (finding)|Orgasmic headache|Preorgasmic headache [averbis.com]
[…] as a specific variant of pre-orgasmic headache. [webmedcentral.com]
The headaches actually fall into two categories: pre-orgasm and post-orgasm. The former is a better tolerated pain that starts in the neck, jaw and head, and builds slowly. [globalnews.ca]
The other type is a sexual benign headache, which doctors also call a pre-orgasm headache. What do they feel like? People typically experience orgasm headaches just before or during an orgasm. [medicalnewstoday.com]
- Excitement
During coitus as sexual excitement increases, the muscles around the shoulder and neck become tense. [braindiseases.blog]
These headaches are usually benign, but occasionally are caused by intracranial hemorrhage and cerebral infarction, especially if the pain is sudden and severe. [1] They may be caused by general exertion, sexual excitement, or contraction of the neck [en.wikipedia.org]
Description: Headache precipitated by sexual activity, usually starting as a dull bilateral ache as sexual excitement increases and suddenly becoming intense at orgasm, in the absence of any intracranial disorder. [ichd-3.org]
Symptoms of a Sexual Headache A sexual headache can feel like a dull ache in the head and neck that gets worse as excitement builds up. [vanquishheadacherelief.com]
Other risk factors may include obesity, certain sex positions (such as kneeling), and degree of sexual excitement. [sexinfo.soc.ucsb.edu]
- Post-Coital Headache
Let us discuss post-coital headache also at times referred to as orgasmic headache. What is post coital headache? The history is quite typical. This is a throbbing and at times intense headache which comes on at or near the height of orgasm. [braindiseases.blog]
Coital Headache Treatment There are two types of sexually-associated headaches: pre-orgasmic headache, and orgasmic headache, or post-coital headaches. [migrainesurvival.com]
DR BYRNES: Post-coital headaches are thought to occur in about 1pc of the population. They are more common in men. Those who are middle-aged, overweight and unfit are at risk. [independent.ie]
These headaches are known medically by various names, such as: Post-coital headache Sexual headache Orgasmic headache Coital cephalgia Coital cephalalgia The words cephalgia and cephalalgia are alternative spellings of a medical word meaning headache. [netdoctor.co.uk]
- Meningism
A CT scan of the brain is ordered and read by the radiologist as normal (Figure 1) ; you then recommend a lumbar puncture (LP), but the patient refuses despite all the terrible things you tell him may happen if he has an aneurysm or meningitis. [neurologytimes.com]
General physical, neurological and fundoscopic examinations of the patient including blood pressure and meningeal signs were performed. Hemogram and routine biochemistry including liver and renal function tests and sedimentation ratio were normal. [ncbi.nlm.nih.gov]
Lamonte M, Silberstein SD, Marcelis JF: Headache associated with aseptic meningitis. Headache 1995, 35: 520–526. 71. [thejournalofheadacheandpain.biomedcentral.com]
Infectious Intracranial infection Abscess, subdural empyema, meningitis Regional infection Otitis, sinusitis, orbital cellulitis, tonsillitis, dental infections, stomatitis General Bacterial: septicemia, endocarditis, tuberculosis Viral: measles, hepatitis [reliasmedia.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
Treatment, when necessary, is usually indomethacin and/or propranolol. [americanmigrainefoundation.org]
Sexual headaches: Case report, review, and treatment with calcium blocker. Headache 1991;31:141-5. [smjonline.org]
Pre-emptive treatment Propanolol hydrochloride ( Inderal) is effective in the prophylaxis of HSA [19]. [bjmp.org]
For this patient, prophylactic treatment with beta-blockers and/or preemptive therapy with indomethacin was successful. [ncbi.nlm.nih.gov]
Fortunately, treatment to prevent a recurrence of benign sexual headaches is both simple and effective. [wkhs.com]
Prognosis
Primary HAS has an excellent prognosis. [smjonline.org]
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]
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]
Even in chronic HAS, the prognosis is favourable, with remission rates of 69% during an observation period of 3 years”. [drmarkgriffiths.wordpress.com]
Headache Associated With Sexual Activity: Prognosis and Treatment Options. Cephalalgia, 2007:1265 -1270 vol. 27: Available at: http://cep.sagepub.com/cgi/content/abstract/27/11/1265 [migrainesurvival.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.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.m.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]
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]
[…] 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.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]
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]
Pathophysiology HSA are not clearly understood but by definition lack serious underlying disease. They are however, unpleasant, frightening, repetitive and episodic. [bjmp.org]
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]
You could also take a more passive role during sex to help prevent or ease the pain of a sex headache. [healthline.com]
It may be prevented by postponing orgasm. It is the most common type of headache associated with sexual activity. [patient.info]
Other than avoiding sex, options include ceasing sexual activity before orgasm (which may shorten the duration of the headache or even prevent it) or taking medication (such as anti-migraine medication or beta blockers) prior to sex (to prevent a headache [bodyandsoul.com.au]