Orgasmic Headache Research Articles

Sexual Behavior, Function and Satisfaction in Headache Associated with Sexual Activity: A Systematic Review of Literature

Introduction: Headache associated with sexual activity (HSA) is the painful event of head and neck precipitated only by sexual activity. The negative impact of sexuality is expected to be more severe in HSA patients and their partners than other headache disorder. In addition, social and cultural taboo may conceal sexual problem or hinder seeking counseling for sexual perplexity. A sufficient scientific evidence is therefore needed to clarify the misunderstanding and schedule appropriate education in clinical practice. Methods: A systematic review of literature was completed to elucidate the sexual behavior, function and satisfaction in HSA patients and their partners. Results: A total of 97 publications are eligible after careful screening. However, most of the studies focus on the etiopathogenesis or treatment. Sexual change was mentioned in 23 publications. Orgasmic headache is the most frequent type of HSA. The HSA occurs more frequent in dyadic than extradyadic sexual activity. Intercourse is the leading sexual act for HSA occurrence, following by masturbation. A few patients suffer HSA under specific sexual position, like kneeling, and trigger, such as cannabis. Pain can be rapidly ceased in half of patients when sexual activity was halted. Sexual function and sexual satisfaction may decrease in HSA patient and partner but improve after pain reversal. Conclusions: A shortage of sexuality data of HSA is documented in literature but that still clarifies the extradyadic and masturbatory effect on HSA occurrence. Nevertheless, HSA disturbs sexual function and satisfaction in patients and their partners. The pathogenesis of pain includes two components, the hypersympathetic status and exertional action. Therefore, physician can schedule their education and counseling for HSA according to these findings. Further investigation for sexual function and satisfaction is warranted.

Orgasmic Headache Treated with Nimodipine

Conventional cardiovascular (CV) risk factors identify only half of subjects with incident major adverse CV events (MACE). Hence new markers are needed in high CV risk subjects, as those with erectile dysfunction (ED). A role for dynamic peak systolic velocity (D-PSV) at penile color Doppler ultrasound (PCDU) has been suggested, but it is operator dependent and time consuming. Flaccid penile acceleration (FPA) is a PCDU parameter that reflects PSV, the systolic rise time (SRT), and end diastolic velocity (EDV), arithmetically defined as (PSV−EDV)/SRT.The study aims to verify, in a large series of ED patients, whether FPA has a role in predicting MACE.A selected series of 1,903 patients (aged 54.6 ± 11.7) with a suspected organic component for ED was retrospectively studied from January 2000 until July 2012. A subset of this sample (n = 622) was enrolled in a longitudinal study that ended in December 2007.Several clinical, biochemical, and instrumental (PCDU) parameters were studied.Decreased FPA levels were associated with worse metabolic profile and sexual symptoms. In addition, FPA was positively associated with both total and calculated free testosterone. In the longitudinal study, unadjusted incidence of MACE was significantly associated with lower baseline FPA. When FPA was introduced in a multivariate model, along with D-PSV, after adjusting for age and Chronic Disease Score, lower FPA, but not D-PSV, was associated with incident MACE in lower-risk—i.e., younger (HR = 0.48 [0.23–0.99]), nonhypertensive (HR = 0.59 [0.38–0.92]), nonobese (HR = 0.68 [0.49–0.96]), or nondiabetic (HR = 0.67 [0.49–0.96] subjects; all P < 0.05—but not in higher-risk ones. FPA demonstrated a threshold effect in predicting MACE at a value <1.17 m/s2 which showed a threefold increase in incidence of MACE in apparently lower-risk individuals.FPA is an easily obtained PCDU parameter and capable of identifying adverse metabolic and CV profiles, particularly in apparently lower-risk individuals with ED. Rastrelli G, Corona G, Lotti F, Aversa A, Bartolini M, Mancini M, Mannucci E, and Maggi M. Flaccid penile acceleration as a marker of cardiovascular risk in men without classical risk factors. J Sex Med 2014;11:173–186.

Orgasmic Headache Treated with Nimodipine

Orgasmic headache (OH) is a sudden and severe headache that occurs at the time of or shortly after an orgasm. AIM.: We present the case of typical primary headache associated with sexual activity, especially during an orgasmic period. A 34-year-old man complained of sudden and severe headache during sexual activity, or orgasmic period, for 2 months. The headache developed abruptly with an orgasm and then decreased shortly over a period of 4 ≈ 8 hours. Magnetic resonance angiography revealed severe spasm of the M1 segment of both the middle cerebral arteries. He was treated with oral nimodipine (30 mg every 8 hours), which alleviated the headache and prevented its recurrence. We postulated a pathophysiological relationship between OH and migraine, especially with respect to vasoconstriction, and believe that in such cases, nimodipine may be an effective therapy.

Ischaemic stroke provoked by sexual intercourse

The association between long term risk factors and stroke has been well established, but very little is known about factors that may precipitate acute stroke. We describe two young women presenting with ischaemic stroke triggered by sexual intercourse. Patient 1 presented with a cardioembolic stroke probably secondary to the interaction between a patent foramen ovale and thrombophilic abnormalities; Patient 2, presenting with orgasmic headache, had a cryptogenic striatocapsular infarct. Sexual intercourse should be considered as an unusual, but possible, trigger of cerebral ischaemia, especially in young patients presenting with cryptogenic stroke.

An infundibulum of thalamoperforator arteries: Importance of angiographic images for appropriate diagnosis

Background:The identification of infundibula on noninvasive imaging modalities may be challenging. Because these lesions have generally been viewed as nonpathological, distinguishing them from small or micro-aneurysms is important.Case Description:A 39-year-old male was diagnosed with recurrence of typical orgasmic headache. An outpoutching arising from the distal part of the right P1 at the take-off of thalamoperforator arteries was visualized on noninvasive investigations. The patient was referred to neurosurgery for surgical management of a right P1 aneurysm. Its unusual location and morphology led to be suspicious of an infundibular dilatation. Catheter angiography with 2D projections and 3D rotational reconstruction revealed an infundibulum at the common origin of two thalamoperforators, giving rise to a double-peaked shape, mimicking a true aneurysm, rather than the more characteristic conical shape of an infundibulum.Conclusion:Although noninvasive modalities may identify typical infundibula, the catheter angiogram with 2D projections was critical to establishing the diagnosis. The 3D rotational reconstruction enabled a straightforward understanding of the 3D vascular anatomy. This pyramidal variant of infundibular dilatation should be included in the differential diagnosis of a wide-based nonsaccular arterial contour deformities located in an area of multiple perforators.

Huge supratentorial arachnoid cyst presenting as an orgasmic headache

Headache related with sexual activity (HAS) is a rare benign headache disorder. HAS is classified into pre-orgasmic and orgasmic headache. Increased intracranial pressure secondary to a Valsalva maneuver during orgasm has been proposed as a possible mechanism for orgasmic headache. We report a patient presenting with orgasmic headache associated with large supratentorial arachnoid cyst.

Isolated thunderclap headache during sex: Orgasmic headache or reversible cerebral vasoconstriction syndrome?

Orgasmic headache (OH) is an “explosive” headache that occurs at orgasm. Historically, it was considered benign with no treatment needed. Reversible cerebral vasoconstriction syndrome (RCVS) refers to a group of disorders characterized by recurrent thunderclap headache (TCH) and multifocal vasoconstriction. Patients who have RCVS often recover completely, but some may have persistent neurological deficits. We report a 34-year-old woman who presented with isolated and recurrent TCH at orgasm, which fulfilled the diagnosis of OH. However, she was post-partum and had recent exposure to ecstasy, making her symptoms highly suggestive of RCVS. Brain magnetic resonance angiography showed segmental vasoconstriction. We concluded that she could be considered to have either OH or RCVS. This patient suggests the theory that OH could be a presentation of RCVS. Given that RCVS is potentially treatable, early recognition by clinicians is vital in order to prevent devastating complications.

Thunderclap Headache with Orgasm: A Case of Basilar Artery Dissection Associated with Sexual Intercourse

Background: Headaches associated with sexual intercourse (coital cephalgia) have many different causes and are often divided in the literature into pre-orgasmic and orgasmic headaches. Objective: To present a case of orgasmic headache caused by a basilar artery dissection and to present a literature-based guide to the diagnosis and management of patients presenting with headaches related to sexual activity. Case Report: We report the case of a 34-year-old man without significant past medical history who presented to the Emergency Department with two episodes of orgasmic headache caused by basilar artery dissection. Conclusions: The cause of headaches related to sexual activity range from the benign to the life-threatening. Due to the dynamics of cerebral blood flow during sexual intercourse, basilar artery dissections and aneurysms should be considered in patients with sudden-onset headaches during orgasm. Appropriate brain imaging and, possibly, lumbar puncture may assist in identifying potentially life-threatening causes of coital headaches.

Orgasmic Headache Responsive to Greater Occipital Nerve Blockade

We present a male with headache related to sexual activity. An injection of steroid and local anesthetic combination was applied to the greater occipital nerve of the symptomatic site. The orgasmic headache stopped after the procedure.

Triptans in Orgasmic Headache

Orgasmic headache (headache associated with sexual activity type 2 according to the International Headache Society classification) is a sudden severe headache which occurs at orgasm. Experiences with triptan therapy are described. Two out of four patients with severe headache continuing for >2 h had a positive response to acute triptan therapy. Two out of three patients using triptans as short-term prophylaxis reported a reliable response on several occasions. Triptans might be a treatment option to shorten orgasmic headache attacks after the diagnosis is clear and, particularly, subarachnoid haemorrhage has been excluded. In patients who chose to predict their sexual activity, short-term prophylaxis with oral triptans 30 min before sexual activity might be a therapeutic option in those not responsive to or not tolerating indomethacin.

Primary Headaches Associated with Sexual Activity—some Observations in Indian Patients

Primary headache associated with sexual activity appears to be relatively uncommon in a clinic-based study in Indian patients. Only 24 patients (M:F 18:6) were encountered over a 20-year period (1985-2004). Of the 18 male patients, 14 (age 33-42 years) had preorgasmic headache of tension-headache type for 2-8 months, one patient (age 58 years) had orgasmic headache of vascular type for 1 month and three subjects (age 19-23 years) had masturbatory headache also simulating tension-type headache for 3-7 weeks. These observations are at variance with those generally reported from western countries. Of the six female patients, four (age 26-32 years) had typical orgasmic headache of the vascular type (for a few months to a few years), only one of whom had been a migraine sufferer. One patient (age 35 years) presented with a single episode of thunderclap headache where angiography had been negative. Another female subject (age 30 years) experienced typical orgasmic headache only during masturbation but not during actual sexual intercourse. Occurrence of sexual headaches in both male and female subjects had been unpredictable. Few had associated migraine and none ever experienced exertional headache.

Dissecting Aneurysm of the Basilar Artery as a Cause of Orgasmic Headache

A 39-year-old woman experienced recurrent, severe bursting headache which was abruptly developed at the time of orgasm. Both magnetic resonance angiography and conventional angiogram of the brain confirmed dissecting aneurysm of the basilar artery. After the neuroradiological intervention using a stent was performed, she has been totally free of the orgasmic headache during the follow-up period for about one year.

September 23 Highlights

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 …