Clinical features, imaging findings and outcomes of headache associated with sexual activity.
OBJECTIVE
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%).


CONCLUSIONS
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.
Neurological Institute, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan.
Yen-Chi
YC
Yeh
Jong-Ling
JL
Fuh
Shih-Pin
SP
Chen
Shuu-Jiun
SJ
Wang
D001921:Brain / Q000098:blood supply / Q000503:physiopathology; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006261:Headache / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D012725:Sexual Behavior