Short communicationRecurrent emotion-triggered headache following primary headache associated with sexual activity
Introduction
Primary headache associated with sexual activity (PHSA) has been a well-known entity since its initial description by Kriz in 1970 [1]. In the second edition of the International Classification of Headache Disorders (ICHD-II), PHSA was subdivided into two categories: type 1 and type 2. Type 1, the so-called ‘preorgasmic’ headache, starts as a dull ache in the head and neck and increases with sexual excitement. Type 2, the more common and more worrisome ‘orgasmic’ headache, is a sudden severe (‘explosive’) headache that occurs at orgasm [2]. Although a previous population-based epidemiological study reported that the lifetime prevalence of PHSA was approximately 1% [3], it is very likely that the prevalence of PHSA was underestimated in previous studies because patients are sometimes reluctant to provide a detailed report of what happened during sex. After the exclusion of structural causes, such as subarachnoid hemorrhage (SAH) or arterial dissection, the prognosis of PHSA is good, and the headache disappears without any specific treatment in the majority of patients [4]. However, in many patients, this ‘benign’ headache does not abate after a single attack. Rather, the headaches tend to recur in clusters, forming a ‘bout’ of headache attacks [5], [6]. The presence of bouts in PHSA patients suggests that these patients are more prone to headaches after the first attack of PHSA. In this report, we describe a woman who developed recurrent, emotion-triggered, severe pulsating headaches following a bout of PHSA.
Section snippets
Case report
A 44-year-old housewife was admitted to our hospital due to headaches associated with sexual activity. Four days prior to admission, she suddenly developed a severe, pulsating holocephalic headache during coitus at the moment of orgasm. The headache was maximal at onset, remained severe for 30 min, and then rapidly resolved without medication. There was no associated nausea, vomiting, photo- or phonophobia, dizziness, motor or sensory disturbances, or clouding of consciousness. Two days later,
Discussion
The occurrence of bouts of headache in patients with PHSA suggests that the initial headache facilitates a mechanism that causes the headache to recur, leaving the patients in a headache-prone state. The cerebral hemodynamic or neurochemical changes that take place during sexual activity and would not normally induce pain may easily trigger headaches in patients in this headache-prone state. The cause of this headache-prone state in patients with PHSA remains unknown. Although an abnormal
Acknowledgement
This work was supported by the 2006 Inje University research grant.
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