September 23 Highlights

Abstract

Frese et al. analyzed the clinical features of this headache in 51 patients. They found a male preponderance. Most patients have an explosive pain at orgasm. Attacks were not related to any particular sexual habit. There was a high comorbidity with other primary headache disorders. see page 796 Commentary by David W. Dodick, MD Headache associated with sexual activity . . . gets your attention There are few headaches that grab the attention of patients and physicians more than those associated with sexual activity. Apart from their noteworthy and peculiar intrusiveness, these headaches are most often apoplectic in onset, occur at the moment of orgasm, and as such, closely resemble the thunderclap headache sometimes associated with potentially catastrophic intracranial diseases such as subarachnoid hemorrhage (SAH). The physician’s apprehension is justifiably heightened by several facts: sudden severe headache is the most common symptom of a SAH, the sole manifestation in about 12% of cases, and precedes a catastrophic rebleed in up to 50% of patients.1,2⇓ Moreover, subarachnoid hemorrhage occurs during sexual activity in up to 11% of cases. Headache associated with sexual activity (HSA) itself often occurs repeatedly and can be quite debilitating. Therefore, any attempt to elucidate the distinguishing clinical features and underlying mechanism of this disorder is welcome. The recently revised diagnostic criteria of the International Headache Society distinguish between two types of HSA: preorgasmic (previously known as HAS type I) and orgasmic headache (previously known as HAS type II). The main distinguishing feature is the presence or absence of a headache that gradually intensifies until orgasm in preorgasmic compared to the sudden onset of a headache simultaneous with orgasm in the latter. There was insufficient evidence to provide more explicit details regarding their duration, associated symptoms, and other clinical features that may prove useful to clinicians …