Late presentation of primary headache associated with sexual activity: is non-invasive angiography worthwhile?

Abstract

The place of angiography in late presentation of headache associated with sexual activity has not been defined, unlike the situation with acute presentations. In a cohort of patients fulfilling diagnostic criteria for primary headache associated with sexual activity and presenting late (at least three weeks after headache onset), those undergoing non-invasive angiography showed no abnormalities. It is suggested that non-invasive angiography is not routinely indicated in late presentations of headache associated with sexual activity.

Transient Acute Neurologic Sequelae of Sexual Activity: Headache and Amnesia

“…In late presentations (>10–14 days), sometimes occasioned by patient embarrassment at the circumstances of onset, CT and CSF are not informative and hence, noninvasive magnetic resonance angiography (MRA) may be considered, as in late presentations of possible SAH. However, in a small study of late‐presenting PHSA, of both preorgasmic and orgasmic types, MRA was invariably negative [6]. Hence, if clinical diagnosis is secure, MRA is not mandatory in late‐presenting cases.…”

“…Clinically, preorgasmic PHSA is a bilateral aching, which builds gradually during sexual activity, whereas orgasmic PHSA has a sudden onset at the point of orgasm. Of these variants, the orgasmic type is the more common by a ratio of 2–4:1 [5,6]. Outpatient clinic cohorts of PHSA, admittedly a biased sample, show an age range of 19–56 years with a mean age of first presentation around 40 years, suggesting these are not individuals in the first flush of sexual vigor, and with a male preponderance (3–4:1) [5,6].…”

“…Of these variants, the orgasmic type is the more common by a ratio of 2–4:1 [5,6]. Outpatient clinic cohorts of PHSA, admittedly a biased sample, show an age range of 19–56 years with a mean age of first presentation around 40 years, suggesting these are not individuals in the first flush of sexual vigor, and with a male preponderance (3–4:1) [5,6]. A third type of headache associated with sexual activity was described: a low pressure (postural) headache ascribed to dural cerebrospinal fluid (CSF) leak induced by vigorous sexual activity [4], but this has been reclassified [3], in part because it had only been described in a single article.…”

Concurrence of primary headaches: Lane and Davies (2006) revisited

“…To further examine the validity of Lane and Davies’s hypothesis, concurrence of multiple primary headaches in individual patients has been further examined by reviewing data from two previous prospective surveys reported from general neurology outpatient clinics, looking at patients with primary headache associated with sexual activity (PHSA) [ 2 ] and trigeminal autonomic cephalalgias (TACs) [ 3 ].…”

Not all morning headaches are due to brain tumours

“…There are no specific data, but it would seem likely that most episodes occur during the evening or night hours (although the patients are clearly not asleep). The mean age of onset was 39 years in a series of patients attending a dedicated headache clinic,11 and the age range in a series presenting to general neurology clinics was 19–56 years (mean 42 years) 12. These data, admittedly from biased samples, suggest that it is generally not individuals in the first flush of sexual vigour but those of a certain maturity who are most likely to be both affected and to consult; a group whose sexual activities may, for various domestic and occupational reasons, be restricted to certain times of the day, or more precisely, night.…”