Orgasmic migraine aura: Report of two cases

Abstract

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.

Post orgasmic illness syndrome: what do we know till now?

“…Sexual function interview focusing on ejaculatory disorders and the relationship with the partner should be recorded. The duration of symptoms must be well noted since it is an essential factor of the thorough history in making differential diagnosis [2, 7, 12, 23].…”

“…Careful physical exam needs to be done, including a digital rectal examination (DRE) after a midstream urine sample has been collected for urine dipstick, microscopic analysis and culture [2, 7, 12, 23].…”

“…Brain and medullar MRI may be needed to rule out an intracranial lesion or hemorrhage (arteriovenous malformation) that might lead to a headache after ejaculation [23].…”

A Rare Primary Headache Disorder: Headache Associated With Sexual Activity

“…Albeit it is classified as primary, at first onset it can be a symptom of subarachnoid hemorrhage, cerebral venous thrombosis, stroke, carotid artery dissection or reversible cerebral vasoconstriction syndrome therefore intracranial pathologies should be reminded on differential diagnosis so neurological (MR imaging ), neurovascular imaging (MR angiography, MR venography ) and transcranial doppler ultrasonography must be performed (11,12).…”

Topiramate for the Prevention of Primary Headache Associated With Sexual Activity: The Third and Fourth Case Reports

“…There are 3 cases reporting the efficacy of calcium channel blockers (1 of diltiazem 7 and 2 of nimodipine 8 ). There are single positive case reports of nimodipine for migraine aura without headache 9 and lamotrigine for migraine with aura 10 . Topiramate might also be effective as these cases suggest.…”