headache (benign coital)

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Coital cephalgia is a headache related to sexual activity usually at or near orgasm (1):

  • there may be one episode or several with no defined periodicity
  • there is usually a short course, but occasionally it can have a duration of years
  • usually no identifiable underlying cause
  • may be associated with migraine or tension headache
  • incidence is higher in men than women.

The classical orgasmic headache is typically severe, throbbing, or explosive in nature, beginning at the moment of orgasm or shortly thereafter (2)

  • this particular type of headache could be classified within the group of thunderclap headache (TCH)

The first time a patient experiences post-coital cephalgia the differential diagnosis includes subarachnoid haemorrhage (SAH)

  • differential diagnosis with the sentinel headache observed during the development of an aneurysmal rupture is extremely important (2)
    • this intense, sudden type of headache occurs in 30% to 60% of patients days or weeks before rupture of the aneurysm, which seems to result from partial rupture with leakage of blood
    • in about 50% of patients, this "warning sign" is abrupt in onset and may be very intense
    • all patients with TCH should be investigated with at least a CT scan and MR angiography, since this type of headache is not a frequent benign recurrent headache disorder, and may represent a serious underlying process (2)

As a pattern to the headaches becomes apparent the diagnosis becomes clear.

A NSAID e.g. indomethacin, may be used as analgesia if not contraindicated.

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:

  1. BMJ 1992;305: 1129
  2. Valenca MM et al. Cerebral vasospasm and headache during sexual intercourse and masturbatory orgasms. Headache. 2004 Mar;44(3):244-8.

Last reviewed 01/2018

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