Multiple sclerosis and Moyamoya angiopathy: Mimic and misdiagnosis

Headache Associated with Sexual Activity Unveiling Moyamoya Disease

“…These transient perfusion-dependent neurological symptoms in MMA often occur in close temporal association with the occurrence of precipitating factors, including heavy exercises and heightened emotional states, both of which may occur during sexual activity. [ 7 , 8 ] It has been long thought that orgasmic headache occur in the setting of trigeminovascular activation, leading to vasodilation from the release of inflammatory neuropeptide. [ 9 ] A similar mechanism leading to the accentuation of dilation of leptomeningeal collaterals may be underpinning the headache associated with sexual activity in our patient, wherein the physical exercise and heightened emotions associated with sexual activity acted as a precipitating factor.…”

“…A lack of awareness regarding the subtle neurological symptoms of MMA on the part of the treating physician can often lead to delayed diagnosis. [ 4 , 7 ] Our patient was initially considered as having a primary headache associated with sexual activity by his primary physician, and brain imaging was deferred. However, brain and intracranial vascular imaging is warranted in patients presenting with new-onset headache associated with sexual activity.…”