Headache Associated With Sexual Activity: Prognosis and Treatment Options

Abstract

The aim of this study was to provide data on the prognosis and treatment options of headache associated with sexual activity (HSA). Sixty patients diagnosed with HSA between 1996 and 2004 were followed up between 2003 and 2006 at least 12 months after the first interview. The further course of the disease and their contentedness with therapy were requested. On average, the second interview was performed 35.9 months after the first examination. Of the 45 patients who had suffered from single attacks or bouts prior to baseline examination, 37 had no further attacks. Seven patients suffered from at least one further bout with an average duration of 2.1 months. One patient developed a chronic course of the disease after an episodic start. Of the 15 patients with chronic disease at the first examination, seven were in remission and five had ongoing attacks at follow-up. Ten patients received indomethacin for preemptive therapy, with good results in nine patients. Eighteen patients received beta-blockers for prophylaxis, with good results in 15 patients. Episodic HSA occurs in approximately three-quarters and chronic HSA in approximately one-quarter of patients. Even in chronic HAS, the prognosis is favourable, with remission rates of 69% during an observation period of 3 years. For patients with longer-lasting bouts or with chronic HSA, prophylactic treatment with beta-blockers or preemptive therapy with indomethacin are often successful.

Indomethacin-Responsive Headaches

“…Cough headache has been treated effectively with acetazolamide [79] and methysergide [80] in open-label trials. Propranolol has been used to treat exercise [40] and sex headaches [81]. Primary stabbing headaches often do not require treatment, but if treatment is required, then celecoxib [82], nifedipine [83], melatonin [84], and gabapentin [85] can be tried instead of indomethacin.…”

Headache Associated With Sexual Activity: A Current Overview Accompanied By Cases

“…Bu tip baş ağrılarının dörtte üçü epizodik seyir ile (cinsel aktivitenin devam etmesi halinde arada bir aydan uzun süreli remisyon dönemleri olan en az iki atak vardır), geri kalan dörtte biri ise kronik seyir ile (atak dönemi on iki aydan uzundur, remisyon dönemleri ise dört haftadan uzun sürmez) devam etmektedir (19). Bazı hastalarda baş ağrısı başladığında cinsel aktivitenin kesilmesi veya daha pasif bir rol üstlenilmesi ile bu tip baş ağrısının şiddeti azalabilmektedir.…”

“…Naratriptan (2,5 mg) gibi düşük absorbsiyon oranına sahip triptanların cinsel aktiviteden en az 1 saat önce alınması faydalı olabilir. Literatürde ayrıca subkutan (6 mg) / oral (50 mg) sumatriptan, intranazal zolmitritan (5 mg), oral almotriptan (12,5 mg) ve rizatriptan (10 mg) akut veya profilaktik tedavide kullanımı ile ilgili farklı sonuçlar bildirilmiştir (19,21).…”

“…Daha uzun süreli atak dönemlerinin olduğu veya kronik seyirli hastalık durumunda profilaktik tedavi gerekli olabilir (19). Profilakside metoprolol, bisoprolol ve proponalol gibi beta blokörlerin etkinliği gösterilmiştir (8).…”

“…Spontan remisyonların sık olması nedeni ile kısa süreli profilaksinin (2-6 ay) yeterli olacağı düşünülmektedir (19,21).…”