CEPHALEA ON SEXUAL ACTIVITY

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PRIMARY HEADACHE ASSOCIATED WITH SEXUAL ACTIVITY
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Headache associated with sexual activity occurs during sexual activity.

Pain intensity might increase with increasing sexual excitement.

Abrupt explosion of intensity just before or with orgasm is also possible.

Headache can last between 1 min and 24 h with severe intensity and even longer with mild intensity.

ICHD-2 distinguished two subtypes of primary headache associated with sexual activity, which were preorgasmic headache and orgasmic headache.
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Clinical studies could not differentiate between these two subtypes, they are now merged to one single entity in the ICHD-3 beta. More men than women are affected. 

In up to 40% of patients an association between PEH and sexual headache has been observed.

The underlying pathophysiology of this headache disorder remains unresolved.
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One study showed that patients with primary headache associated with sexual activity are more prone to have abnormalities in the cerebral venous circulation.

Twelve out of 19 patients had a venous stenosis, whereas healthy controls did not show any disorder in this study.

Similar results were obtained from patients suffering from primary cough headache or primary exertional headache so that a common underlying pathophysiological mechanism may be expected or these disorders may share a common final pathway leading to headache after strenuous activity.

Propranolol and indometacin might be effective as prophylactic therapy and Triptans can be taken before sexual activity
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