Exertional and sex headache

Abstract

Exertional headache and sexual headache are headache disorders that share some clinical and pathophysiological characteristics. These two headache disorders are both provoked by specific triggers and are highly comorbid with migraine. They account for a small proportion of headache consultations, but potentially devastating secondary causes such as subarachnoid haemorrhage or reversible cerebral vasoconstriction syndromes should be considered. Structural neuroimaging studies, as well as comprehensive vascular imaging of head and neck, are necessary to exclude secondary causes. The diagnosis of primary exertional headache and primary sexual headache should be based on the criteria proposed in the International Classification of Headache Disorders, 3rd edition (beta version). Impaired cerebral autoregulation or venous stenosis has been proposed as possible pathophysiology. Beta blocker and indomethacin might be effective treatment, but large-scale randomized placebo-controlled studies are required to provide solid evidence.