Primary headache syndromes associated with sexual activity

Transient Acute Neurologic Sequelae of Sexual Activity: Headache and Amnesia

“…There is no information as to whether PHSA is related to obesity but it does not seem to be related to hypertension. It does not seem to be more common with affair rather than regular sexual partners, and may also occur during masturbation [12]. What relationship if any PHSA has to anxiety, either generalized or specifically related to sexual performance, has not been examined.…”

“…Simple analgesia is of little benefit. For those rare patients with recurrent events, an empirical trial of prophylactic indomethacin, propranolol, or a calcium channel blocker such as diltiazem may be given [12]. There are no reported trials of relaxation techniques during sex or exploration of anxiety issues.…”

“…The key questions to ask when assessing any patient with acute onset headache relate to the circumstances (not all patients will be ready to admit it occurred during sexual activity), whether headache built up or was instantaneously at its most severe, whether this was the most severe headache ever experienced, and whether there were any associated features such as vomiting or photophobia. "Red flags" mandating further investigation include reduced level of consciousness, meningism, other motor, sensory or visual symptoms, and pain lasting more than 24 hours [12].…”

Pre‐orgasmic headache and cervical carotid artery dissection

“…Articles suggest that whenever HSA appears for the first time a CT of the brain and, if negative, a CSF examination should be performed to exclude a SAH, even if the presentation seems typical for headache associated with sexual activity [2,3]. Furthermore, if the history or the neurological examination suggests arterial dissection, in particular of the vertebral artery, that diagnosis also has to be excluded [4]. Arterial dissection during sexual intercourse is rare.…”