Headaches Induced by Pornography Use

Abstract

A24-year-oldunmarriedmalesoftwareprofessional,notaknown caseofdiabetesorhypertension,presentedwithepisodesofsevere, explodingholocranialheadacheonwatchingpornographicvideos for the last 2 years. The headache would develop gradually over 5 min of viewing videos and would peak within 8–10 min. The intensitywassoseverethathehadtoabortwatching.Therewasno accompanying nausea, vomiting, or phonophobia. Progressively, he started to refrain from viewing videos as a means of avoiding headaches.Therewasnohistoryofheadacheassociatedeitherwith masturbation or with coitus. He had no history of head injury or meningoencephalitis in early childhood. There was no history suggestive of migraine in the family. He did not have a history suggestive of migraine, tension type or exertional headache. A physical and systemic examination was unremarkable. The neurological examination was normal. Magnetic Resonance (MR) Imaging, MR angiography of brain, and electroencephalogram were normal. He was advised non-steroidal anti-inflammatory agent combination (ibuprofen 400 mg and paracetamol 500 mg) halfanhourbeforewatching, towhichhereportedsignificantpain relief. Headaches associated with sexual activity are uncommon (Anand & Dhikav, 2009). Pre-orgasmic headache may be related tospace-occupyinglesions.Orgasmicheadacheisoftensevereand excruciating, whether due to aneurysm rupture or to the explosive component of benign coital headache. Post-orgasmic headache mayoccurasamanifestationofmigraine(Banerjee,1996).Astudy by Frese et al. (2003) stratified headaches associated with sexual activityandfound that there wasamale preponderance. It has two onset peaks (between 20–24 and 35–44 years). It can be dull type, increasing gradually with sexual excitement or explosive type. Paincanbebilateral and diffuseoroccipital.Headacheassociated with sexual activity has not been shown to be dependent upon specificsexualhabits andoccursoftenafterhavingsexualactivity with partner or during masturbation. There was a high co-morbidity with migraine and other types of headaches (e.g., benign exertionalandtension-type).Themechanismofheadacheinduced bysexualactivityismainlyatrigeminal-vasculareffect,butthereis a definite muscular component (Anand & Dhikav, 2009). Muscularcontractionplaysamajorrole,especiallyinmilderheadaches that become more intense as the sexual excitement increases. The probable mechanisms behind occurrence of headache in the present case could be alteration of nocioceptive mechanisms in the trigemino-vascular system with increased pain sensitivity associatedwitha heightenedemotional state associatedwithviewing pornorgraphy.