Primary headache associated with sexual activity

Introduction
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By Yen-Chi Yeh MD

Primary headache associated with sexual activity is also known as or subsumes Benign coital cephalgia, Coital headache, and Orgasmic cephalgia. -ed.

Sexually related headache may be primary or secondary. In this article, the author updates the discussion of primary headache associated with sexual activity. This headache can start as a dull bilateral ache with increasing sexual excitement or suddenly become intense with orgasm. Neuroimaging studies of both brain parenchyma and cerebral vasculature are recommended for all patients to exclude secondary causes. On the first onset, subarachnoid hemorrhage and arterial dissection must be  ruled out. Reversible cerebral vasoconstriction syndrome should be considered until proven otherwise in those with multiple attacks of sexual headaches.

Key points

  • Evaluation of new-onset headache associated with sexual activity should exclude secondary causes.
  • Secondary causes of headache associated with sexual activity include subarachnoid hemorrhage, arterial dissection, stroke, and reversible cerebral vasoconstriction syndrome.
  • Prognosis of primary headache associated with sexual activity is good, with 69% of cases remitting at 3 years.
  • Non-drug treatments include weight loss, an exercise program, a more passive role during intercourse, variation in positions, or limitation of sexual activity during a given day.
  • Drug treatments include propranolol, indomethacin, and triptans.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
Anesthesia
References cited
Contributors