P-PA004. Severe headache post coital: A case report

Abstract

Introduction . Headache associated with sexual activity (HAS) is an acute headache that is often related to sexual intercourse. It may also be classified as benign or malignant. Though largely benign, the headache may seldom be a symptom of an underlying life threatening neurologic disorder such as aneurysmal subarachnoid hemorrhage. Results . We report a case of 40-year-old Indonesian man, admitted to hospital because of sudden onset of severe headache followed by nausea and vomiting during sexual intercourse, particularly at the time of orgasm. This complaint had been repeated three times a month. The patient had history of hypertension and diabetes mellitus. There was no history of head trauma. Neurological examination was normal. There were no signs of coagulopathy on the results of laboratory tests. A cerebral magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) showed a chronic active subdural hematoma and suspected left transverse sinus thrombosis. The patient underwent surgery and the complaints improved. Conclusion . Headache associated with sexual activity (HAS) could be primary or secondary. HAS is classified as secondary when it is associated with an underlying intracranial pathology, notable among which are cerebral artery aneurysms and other vascular disorders. Based on clinical criteria and neuroimaging result, these patients met the diagnostic criteria suspected for secondary HAS. To the best of our knowledge, this is the first case of subdural hematoma due to suspected left transverse sinus thrombosis in association with the physical exertion associated with sexual intercourse. Headache after sexual intercourse should always be carefully evaluated by cerebral imaging. The case highlights the importance of paying attention to post coital headache.