Primary headaches associated with sexual activity respond to topiramate therapy: a case report

Primary headaches are rarely associated with orgasms. Indomethacin at doses of 25-50 mg/day taken 30-60 minutes prior to sexual activity may prevent headaches. Propranolol and metoprolole have been used for headaches that consistently emerge during frequent sexual activity of any type. It is also known that topiramate is useful for treating migraines, but it is rarely used for other primary headaches. The role of topiramate in the treatment of headaches associated with sexual activity is unclear. Indomethacin and propranolol could not be used in our patient who, besides sexual activity-associated headaches, suffered from gastritis and diabetes mellitus. Thus, topiramate (50 mg/day) was used prophylactically, and sexual activity-associated headaches did not recur during 6 months of topiramate therapy. This is the first report of positive response to topiramate as prophylactic treatment against sexual activity-associated headaches when propranolol and indomethacin are contraindicated.