Expert Opinion: Sexual Intercourse Followed by Headache and Transient Monocular Visual Loss

Abstract

CLINICAL HISTORY Thirty minutes after sexual intercourse, this 48-year-old woman noticed a slight headache on the top of her head. Fifteen minutes later, she developed a severe left-sided throbbing headache with visual symptoms but without nausea, light, or noise sensitivity. She had a sudden warm liquid feeling in the left eye and then vision in the inferior field of the left eye became dark and, within about 3 seconds, vision in the entire field of the left eye was dark.The vision cleared completely in a segmental fashion in about 30 to 45 minutes. Acetaminophen with codeine decreased the intensity of the headache. A computerized tomography (CT) of the brain without contrast performed about 2 hours after the onset of the symptoms was negative. When I saw her the next afternoon, the left-sided headache was slight. She had no further visual symptoms. She reported a 26-year history of headaches about once or twice per month described as a top or back of the head throbbing with light and noise sensitivity decreased by acetaminophen with codeine and lasting about 8 hours. Her menses was a common trigger. Past medical history was negative. Blood pressure and pulse were normal. There were no carotid bruits. Cardiac auscultation was normal. The neurological examination was normal. Questions.—Is this a case of retinal migraine? Is further testing indicated?