Diagnosis and classification of headache associated with sexual activity using a composite algorithm: A cohort study

Cephalalgia ◽  
2021 ◽  
pp. 033310242110289
Author(s):  
Po-Tso Lin ◽  
Yen-Feng Wang ◽  
Jong-Ling Fuh ◽  
Jiing-Feng Lirng ◽  
Yu-Hsiang Ling ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Sexual Activity ◽  
Diagnostic Algorithm ◽  
Primary Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Artery Dissection ◽  
Vascular Disorders ◽  
Cerebral Vasoconstriction ◽  
Clinical Profiles ◽  
Secondary Causes

Background To differentiate primary headache associated with sexual activity from other devastating secondary causes. Methods In this prospective cohort, we recruited consecutive patients with at least 2 attacks of headache associated with sexual activity from the headache clinics or emergency department of a national medical center from 2005 to 2020. Detailed interview, neurological examination, and serial thorough neuroimaging including brain magnetic resonance imaging and magnetic resonance angiography scans were performed on registration and during follow-ups. Patients were categorized into four groups, i.e. primary headache associated with sexual activity, reversible cerebral vasoconstriction syndrome, probable reversible cerebral vasoconstriction syndrome, and other secondary headache associated with sexual activity through a composite clinic-radiological diagnostic algorithm. We compared the clinical profiles among these groups, including sex, age of onset, duration, quality, and clinical course (“chronic” indicates disease course ≥ 1 year). In addition, we also calculated the score of the reversible cerebral vasoconstriction syndrome2, a scale developed to differentiate reversible cerebral vasoconstriction syndrome from other intracranial vascular disorders. Results Overall, 245 patients with headache associated with sexual activity were enrolled. Our clinic-radiologic composite algorithm diagnosed and classified all patients into four groups, including 38 (15.5%) with primary headache associated with sexual activity, 174 (71.0%) with reversible cerebral vasoconstriction syndrome, 26 (10.6%) with probable reversible cerebral vasoconstriction syndrome, and 7 (2.9%) with other secondary causes (aneurysmal subarachnoid hemorrhage (n = 4), right internal carotid artery dissection (n = 1), Moyamoya disease (n = 1), and meningioma with hemorrhage (n = 1)). These four groups shared similar clinical profiles, except 26% of the patients with primary headache associated with sexual activity had a 3 times greater chance of running a chronic course (≥ 1 year) than patients with reversible cerebral vasoconstriction syndrome. Of note, the reversible cerebral vasoconstriction syndrome2 score could not differentiate reversible cerebral vasoconstriction syndrome from other groups. Conclusion Our composite clinic-radiological diagnostic algorithm successfully classified repeated headaches associated with sexual activity, which were predominantly secondary and related to vascular disorders, and predicted the prognosis. Primary headache associated with sexual activity and reversible cerebral vasoconstriction syndrome presented with repeated attacks of headache associated with sexual activity may be of the same disease spectrum.

scholarly journals Primary headache associated with sexual activity

Pain medicine ◽  
2019 ◽  
Vol 4 (1/1) ◽  
pp. 15-16
Author(s):  
В В Білошицький
Keyword(s):  
Sexual Activity ◽  
Primary Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction

Пацієнт, 48 років, звернувся зі скаргами на приступи інтенсивного головного болю, що виникає під час оргазму. Уперше такий приступ виник за 13 днів до консультації під час статевого акту з новою партнеркою, який супроводжувався значним сексуальним збудженням. Напад повторився через 3 дні під час наступного статевого акту і ще за 6 днів після другого. Відчуття болю з’являється в лівій потиличній ділянці голови, інтенсивність зростає протягом 3 секунд, допоки не виникає надзвичайно сильний біль (VAS 8–9), який при розпитуванні пацієнт характеризує як найсильніший у житті («наче лусне голова»). Біль локалізується в лівій потилично-скроневій ділянці з відчуттям «тиску на очі». Інтенсивний біль тривав 1,5–2 хвилини, потім його вираженість зменшувалася до VAS 3, і такий остаточний біль зберігався до 1,5 години. На початку на-паду пацієнт приймав 2 таблетки спазмалгону (метамізол натрію моногідрат, пітофенону гідрохлорид, фенпіверинію бромід).Головний біль не супроводжується нудотою, фото- й фонофобією. Також немає вегетативних проявів, характерних для тригемінальних вегетативних цефалгій (ін’єкція кон’юнктиви та/або сльозотеча, закладення носа та/або ринорея, набряк повік, потіння лоба та обличчя, почервоніння лоба та обличчя, відчуття закладення вуха, міоз та/або птоз).Під час третього нападу пацієнт, відчувши «пульсацію в голові», зменшив активність і рівень збудження, внаслідок чого біль не сягнув вище рівня VAS 4 і згодом припинився. Пацієнт зазначає, що замолоду мав один епізод головного болю (не пов’язаного з сексуальною активністю), що тривав кілька днів. Із 35-річного віку з’явилися головні болі тієї ж локалізації (ліва потилично-скронева ділянка), тупі, низької інтенсивності (VAS 3), які виникають при фізичних навантаженнях, особливо пов’язаних із нахилами («качання черевного преса» – не більше 15 нахилів, робота на городі – сапання).При нападах інтенсивного головного болю, що настають вибухоподібно, у тому числі при першому нападі головного болю, пов’язаного з сексуальною активністю, завжди слід виключати такі види патології, як субарахноїдальний крововилив, внутрішньочерепна й екстракраніальна артеріальна дисекція та синдром оборотної мозкової вазоконстрикції – reversible cerebral vasoconstriction syndrome (RCVS). Ми призначили мультиспіральну комп’ютерну томографію (МСКТ) черепа й головного мозку з МСКТ-ангіографією, яка не виявила патологічних змін.

Orgasmic migraine aura: Report of two cases

Cephalalgia ◽  
2018 ◽  
Vol 39 (1) ◽  
pp. 153-156 ◽  
Author(s):  
Heather Angus-Leppan ◽  
Alice Caulfield
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Sexual Activity ◽  
Case Reports ◽  
Primary Headache ◽  
Neurological Symptoms ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Migraine Aura ◽  
Cerebral Vasoconstriction ◽  
Underlying Causes

Background Paroxysmal neurological symptoms occurring with sex cause considerable anxiety and sometimes have a serious cause. Thunderclap headache is the most well-known and requires urgent investigation at first presentation for subarachnoid haemorrhage and other significant pathologies. After exclusion of underlying causes, many prove to be primary headache associated with sexual activity. Orgasmic migraine aura without headache is not currently recognised as a clinical entity. Case reports We report two patients with acephalgic orgasmic neurological symptoms fulfilling the criteria for migraine aura. Conclusions The incidence of acephalgic orgasmic migraine aura is unknown. It should be considered as part of the differential of paroxysmal sex-related neurological symptoms, and clinically differentiated from fixed deficits, reversible cerebral vasoconstriction syndrome and post-orgasmic illness syndrome.

Clinical features, imaging findings and outcomes of headache associated with sexual activity

Cephalalgia ◽  
2010 ◽  
Vol 30 (11) ◽  
pp. 1329-1335 ◽  
Author(s):  
Yen-Chi Yeh ◽  
Jong-Ling Fuh ◽  
Shih-Pin Chen ◽  
Shuu-Jiun Wang
Keyword(s):  
Sexual Activity ◽  
Clinical Features ◽  
Age At Onset ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
Imaging Findings ◽  
Cerebral Vasoconstriction ◽  
The Central Nervous System ◽  
Headache Clinic ◽  
Neurovascular Imaging

Objectives: To study the clinical profiles, imaging findings and outcomes and field test the diagnostic criteria proposed by the International Classification of Headache Disorders, 2nd edition (ICHD-II) in patients with headache associated with sexual activity (HSA). Methods: We recruited 30 patients (16 men, 14 women, mean age at onset 40.2 ± 10.0 years) with headache associated with sexual activity at a headache clinic from 2004 to 2009. None of the patients had neurological deficits at onset. Results: Twenty patients (67%) had secondary causes, including one subarachnoid hemorrhage, one basilar artery dissection, and 18 cases reversible cerebral vasoconstriction syndrome (RCVS). Ten patients (33%) had primary HSA. The demographics, headache profiles, drug response and clinical course were similar between primary and secondary HSA. Compared to prior studies done in Western societies, our patients had similar clinical features but with a higher ratio of females (50%) and a higher frequency of chronic course (39%). Discussion: Sixty-seven percent of patients with RCVS could not fulfill the criteria of reversible angiopathy of the central nervous system (Code 6.7.3) proposed by the ICHD-II. The most common reason was headache resolution in more than two months. In addition, 40% of patients with primary HSA could not fulfill the ICHD-II criteria for primary HSA (Code 4.4). Conclusions: Our study found that intracranial vascular disorders were very common in patients with HSA. Thorough neurovascular imaging is required for all patients with HSA.

Pediatric Reversible Cerebral Vasoconstriction Syndrome: Two Unique Cases with a Review of all Reported Children

2021 ◽  
Author(s):  
Neelu Desai ◽  
Rahul Badheka ◽  
Nitin Shah ◽  
Vrajesh Udani
Keyword(s):  
Magnetic Resonance ◽  
Cerebral Arteries ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Neurological Deficits ◽  
Cerebral Vasoconstriction ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy ◽  
Mr Angiogram

AbstractReversible cerebral vasoconstriction syndrome (RCVS) has been well described in adults, but pediatric cases are yet under recognized. We describe two children with RCVS and review similar already published pediatric cases. The first patient was a 10-year-old girl who presented with severe headaches and seizures 3 days after blood transfusion. Brain magnetic resonance imaging (MRI) showed changes compatible with posterior reversible encephalopathy syndrome and subarachnoid hemorrhage. Magnetic resonance angiogram showed diffuse vasoconstriction of multiple cerebral arteries. The second patient was a 9-year-old boy who presented with severe thunderclap headaches. Brain MRI showed isolated intraventricular hemorrhage. Computed tomography/MR angiogram and digital subtraction angiogram were normal. A week later, he developed focal neurological deficits. Repeated MR angiogram showed diffuse vasospasm of multiple intracranial arteries. Both children recovered completely. A clinico-radiological review of previously reported childhood RCVS is provided.

scholarly journals DIAGNOSTICS OF REVERSIBLE CEREBRAL VASOCONSTRICTION SYNDROME: CLINICAL MANIFESTATION AND IMAGING PATTERNS

2018 ◽  
pp. 50-55
Author(s):  
E. G. Klocheva ◽  
V. V. Goldobin
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Clinical Manifestation ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Treatment Modification ◽  
Cerebral Vasoconstriction

Data of 130 patients with thunderclap headache are presented. The data include clinical manifestation analysis and neuroimaging results (magnetic resonance angiography). Magnetic resonance angiography was performed 15 days after acute clinical manifestation and permitted to verify cerebral vasoconstriction, that led to treatment modification with clinical and neuroimaging signs of vasoconstriction reverse.

Reversible cerebral vasoconstriction syndrome associated with fingolimod treatment in relapsing–remitting multiple sclerosis three months after childbirth

2015 ◽  
Vol 21 (11) ◽  
pp. 1473-1475 ◽  
Author(s):  
Markus Kraemer ◽  
Ralph Weber ◽  
Michèle Herold ◽  
Peter Berlit
Keyword(s):  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Conventional Angiography ◽  
Cerebral Vasoconstriction ◽  
Relapsing Remitting ◽  
Relapsing Remitting Multiple Sclerosis

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by acute thunderclap headache, evidence of vasoconstriction in conventional angiography or magnetic resonance angiography and reversibility of these phenomena within 12 weeks. Some triggering factors, for example drugs such as selective serotonin reuptake inhibitors, sumatriptan, tacrolimus, cyclophosphamide and cocaine, or states such as pregnancy, puerperium or migraine have been described. We describe the case of a 29-year-old woman with RCVS associated with fingolimod three months after childbirth. This case represents the first report of RCVS in fingolimod treatment.

scholarly journals Headache in the Emergency Room

2017 ◽  
Vol 13 (02) ◽  
pp. 94 ◽  
Author(s):  
Kourosh Kahkeshani ◽  
Huma U Sheikh ◽  
◽  
Keyword(s):  
Emergency Room ◽  
Primary Headache ◽  
Daily Basis ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Secondary Headache ◽  
Carotid Dissection ◽  
Cerebral Vasoconstriction ◽  
Different Types

Headache is seen in the emergency room (ER) on a daily basis and is a vague symptom, which can be a part of many different types of conditions and diseases. Although most people who come to the ER will have a benign headache, it is important to make sure that dangerous causes of headache are ruled out. There are a number of features that may alert someone to a secondary cause of headache. This article highlights two specific secondary headache syndromes, including carotid dissection and reversible cerebral vasoconstriction syndrome. It also broadly points out other possible causes of secondary headache. The last section focuses on a common primary headache that presents to the ER, migraine and its treatment.

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