Primary headache associated with sexual activity

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By Paul A Shanahan MRCPI BAO and Manjit S Matharu PhD MRCP

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 clinical article, Dr. Paul A Shanahan and Dr. Manjit S Matharu from The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK review primary sexually related headache. For primary headache, benign coital cephalgia is the most common and severe. The headache occurs at orgasm with explosive onset and variable duration. Preorgasmic muscle tension may produce a less severe headache. Subarachnoid hemorrhage due to rupture of aneurysm or arteriovenous malformation or intraparenchymal hemorrhage must be considered and ruled out. Other complications may include dural tear and cerebrospinal leak occurring with the effort of sexual activity. Finally, orgasm may relieve migraine in some cases.

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.