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Diagnosis and classification of headache associated with sexual activity using a composite algorithm: A cohort study
Po-Tso Lin1,2, Yen-Feng Wang1,2,3, Jong-Ling Fuh1,2,3
1Department of Neurology, 46615Taipei Veterans General Hospital, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Cephalalgia : an International Journal of Headache
|July 19, 2021
Summary
Headaches during sexual activity are often secondary to vascular disorders like reversible cerebral vasoconstriction syndrome. A new diagnostic algorithm helps classify these headaches and predict outcomes, suggesting primary and secondary forms may share a spectrum.
Area of Science:
- Neurology
- Vascular Neurology
- Headache Medicine
Background:
- Headaches associated with sexual activity require differentiation from serious secondary causes.
- Distinguishing primary sexual headache from secondary causes like vascular events is clinically crucial.
Purpose of the Study:
- To develop and validate a composite clinic-radiological algorithm for classifying headaches associated with sexual activity.
- To differentiate primary sexual headache from secondary causes, particularly reversible cerebral vasoconstriction syndrome (RCVS).
Main Methods:
- A prospective cohort study enrolled 245 patients with recurrent headaches during sexual activity.
- Patients underwent detailed interviews, neurological exams, and serial neuroimaging (MRI, MRA).
- A diagnostic algorithm classified patients into primary sexual headache, RCVS, probable RCVS, or other secondary causes.
Main Results:
- The algorithm classified all patients: 15.5% primary sexual headache, 71.0% RCVS, 10.6% probable RCVS, and 2.9% other secondary causes (e.g., SAH, dissection).
- Clinical profiles were similar, but primary sexual headache showed a higher chronicity rate (≥1 year) compared to RCVS.
- The RCVS2 score did not effectively differentiate RCVS from other groups.
Conclusions:
- A composite clinic-radiological algorithm reliably classifies headaches associated with sexual activity, predominantly identifying secondary vascular disorders.
- The findings suggest primary sexual headache and RCVS might represent parts of the same disease spectrum.
- The algorithm aids in predicting prognosis for patients experiencing headaches during sexual activity.
