Materiały źródłowe

• #1 4.3 Primary headache associated with sexual activity – ICHD-3

  https://ichd-3.org/other-primary-headache-disorders/4-3-primary-headache-associated-with-sexual-activity/

  4.3 Primary headache associated with sexual activity […] Previously used terms: Benign sex headache; benign vascular sexual headache; coital cephalalgia; coital headache; intercourse headache; orgasmic cephalalgia; orgasmic headache; sexual headache. […] Coded elsewhere: Postural headache occurring after coitus should be coded as 7.2.3 Headache attributed to spontaneous intracranial hypotension because it is most probably due to CSF leakage. […] Description: Headache precipitated by sexual activity, usually starting as a dull bilateral ache as sexual excitement increases and suddenly becoming intense at orgasm, in the absence of any intracranial disorder. […] Diagnostic criteria: […] 1. At least two episodes of pain in the head and/or neck fulfilling criteria B-D […] 2. Brought on by and occurring only during sexual activity

• #2 Primary headache associated with sexual activity (Orgasmic headache)

  https://americanmigrainefoundation.org/live-copy/resource-library/orgasmic-pre-orgasmic-headache/

  Primary headache associated with sexual activity, previously known as orgasmic or pre-orgasmic headache, is a rare headache type brought on by or occurring only during or after sexual activity. […] People with new or never-evaluated headache associated with sexual activity should be carefully assessed by their doctor for an underlying cause and considered for imaging of their brain and the blood vessels in their head to exclude conditions like subarachnoid hemorrhage, arterial dissection and reversible cerebral vasoconstriction syndrome. […] Please refer to the International Classification of Headache Disorders 3rd edition website for more information on the criteria used to diagnosis primary headache associated with sexual activity. […] When diagnosing, care must be taken to rule out other, more serious conditions such as subarachnoid hemorrhage, arterial dissection and reversible cerebral vasoconstriction syndrome. […] Treatment, when necessary, is usually indomethacin and/or propranolol.

• #3 Sex headaches – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sex-headaches/diagnosis-treatment/drc-20377481

  Your provider will likely recommend brain imaging. […] An Magnetic resonance imaging (MRI) of the brain can help detect any underlying causes for your headache. […] In some cases, especially if your headache occurred less than 48 to 72 hours beforehand, a computed tomography (CT) scan of the brain may be done. […] Your provider may also order a cerebral angiogram, a test that can show the neck and brain arteries. […] Sometimes a spinal tap (lumbar puncture) is needed as well especially if the headache started abruptly and very recently and brain imaging is normal. […] The fluid sample can show if there’s bleeding or an infection. […] What tests do I need? […] Your provider is likely to ask you questions, such as: When did you first have a sex headache? […] What, if anything, seems to improve your headaches? […] What, if anything, makes your headaches worse?

• #4 Throbbing Headache: Causes and Treatment

  https://www.webmd.com/migraines-headaches/throbbing-headache-causes

  Throbbing Headache Diagnosis […] To figure out what’s causing your headaches, your doctor will start by doing an exam and asking you questions about your symptoms. For instance: […] What part of your head hurts? […] What makes the pain better or worse? […] How long does the pain last? […] What other symptoms do you have besides throbbing pain? […] What were you doing right before your headache? […] How have you been sleeping? […] Have you recently gone through any stressful events? […] What did you have to eat or drink on the day of your last headache? […] What prescription, over-the-counter, or illegal drugs do you use? […] Does anyone else in your family get headaches or have a headache disorder? […] Because symptoms for many types of headaches can overlap, your doctor may order tests to get more information and rule out other health conditions. That could include:

• #5 What Is Headache? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/headache/guide/

  Primary Headaches Associated With Sexual Activity These headaches are brought on by sexual activity and can happen during or after sex, explains the American Migraine Foundation. They usually affect both sides of the head and are often located in the back of the head. They can be as short as one minute, but in some cases mild pain can linger for up to three days. […] Diagnosing what type of headache a person has can be complex, says Barbara Nye, MD, a neurologist and headache specialist at Atrium Health Wake Forest Baptist in Winston Salem, North Carolina. We really focus on listening to our patients. Much of the information comes from the medical history, and so its really important for patients to reflect on how things have developed and the characteristics of their headache. […] The tests that your doctor orders will depend in part on what they suspect could be causing your headaches. The process of diagnosis may include the following: Medical History Your doctor will want to know about other health conditions you have as well as any medications, supplements, or herbal treatments or teas that you rely on. Family History You will be asked to provide details on any family members who have headaches or migraine attacks, at what age their headaches started, and any other health diagnoses they may have. Some types of headaches, such as migraine, have a genetic component, according to MedlinePlus.

• #6 Primary headache associated with sexual activity | MedLink Neurology

  https://www.medlink.com/articles/primary-headache-associated-with-sexual-activity

  A careful history and physical examination are essential. All patients seen acutely and suspected of having a subarachnoid hemorrhage should have a CT scan and a lumbar puncture. Patients with repeated sexual headaches should have an MRI with MRA examination. […] Composite clinic-radiologic algorithms have been proposed to differentiate and classify headache triggered by sexual activity, ie, primary headache associated with sexual activities, reversible cerebral vasoconstriction syndrome, probable reversible cerebral vasoconstriction syndrome, primary thunderclap headache, and other secondary causes.

• #7 Headache Associated with Sexual Activity—A Narrative Review of Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8400207/

  The most recent and precise official document defining headache associated with sexual activity is the 2018 ICHD-3. Classification distinguishes between primary headache associated with sexual activity (4.3) and probable primary headache associated with sexual activity (4.3.1). According to this classification, primary headaches associated with sexual activity are a single entity with variable presentation and has replaced previously used terms such as: benign vascular sexual headache, coital cephalalgia, coital headache, intercourse headache, orgasmic cephalalgia, orgasmic headache or sexual headache. […] Primary headache associated with sexual activity usually does not present with other abnormalities, e.g., disturbances in consciousness, vomiting, or visual, sensory or motor symptoms, whereas secondary HAWSA can do so. When HAWSA first occurs, it is critical to exclude secondary causes of headache. The differential diagnosis of secondary HAWSA should include all potential causes of thunderclap headache, e.g., subarachnoid hemorrhage, arterial dissection, reversible cerebral vasoconstriction, cerebral ischemic or hemorrhagic stroke, and cerebral venous sinus thrombosis. Other pain syndromes that may mimic HAWSA include trigeminal neuralgia, demyelinating disease, cluster headache, migraine, and chronic paroxysmal hemi-cranias. […] The most important diagnostic methods are magnetic resonance imaging (MRI), computed tomography of the brain (CT) and CT angiography (CTA). Lumbar puncture and CSF analysis may also be a useful diagnostic method.

• #7 Headache Associated with Sexual Activity—A Narrative Review of Literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8400207/

  Headache associated with sexual activity (HAWSA) has accompanied humanity since ancient times. However, it is only since the 1970s that it has become the subject of more extensive and detailed scientific interest. The purpose of this review is to provide an overview of the development of the concept of HAWSA, its clinical presentation, etiopathogenesis, diagnosis and treatment especially from the research perspective of the last 20 years. Primary HAWSA is a benign condition, whose etiology is unknown; however, at the first occurrence of headache associated with sexual activity, it is necessary to exclude conditions that are usually immediately life-threatening. […] According to the ICHD-3, diagnostic criteria for HAWSA include at least two episodes of pain in the head and/or neck fulfilling the following criteria: (1) the headache is brought on by and occurring only during sexual activity, (2) the pain in the head increases in intensity with increasing sexual arousal, and/or it has abrupt explosive intensity just before or with orgasm, (3) the pain lasts from one minute to 24 h with severe intensity and/or up to 72 h with mild intensity, (4) the pain cannot be better accounted for by another ICHD-3 diagnosis.

• #8 Headache after Sex: Symptoms and Treatment | Doctor

  https://patient.info/doctor/primary-sexual-headache

  Primary sexual headache has been re-classified by the International Headache Society (IHS) as primary headache associated with sexual activity (PHASA). The exact prevalence in not known, although it is more common in men. […] Neuroimaging is therefore needed to distinguish primary, benign causes of sexual headache from secondary, potentially life-threatening causes. […] PHASA is included in the list of 'Other Primary Headache Disorders’, which is the fourth group of primary headaches in the International Classification of Headache Disorders third edition (ICHD-3). […] The IHS suggest the following diagnostic criteria: A. At least two episodes of pain in the head and/or neck fulfilling criteria BD. B. Brought on by and occurring only during sexual activity. C. Either or both of the following: 1. Increasing in intensity with increasing sexual excitement. 2. Abrupt explosive intensity just before or with orgasm. D. Lasting from one minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity. E. Not better accounted for by another diagnosis in the new classification system (third edition). […] Even though the presentation may fit the IHS classification criteria, a low threshold should be maintained for ruling out subarachnoid bleeding. […] Careful history and examination are essential, but neuroimaging is required on the first episode.

• #9 Acute Headache in Adults: A Diagnostic Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/acute-headache-adults.html

  For less urgent cases, magnetic resonance imaging of the brain is preferred for evaluating headaches with concerning features. […] Patients with headache and red flags (acute thunderclap headache, fever with meningeal irritation on physical examination, papilledema with focal neurologic signs or impaired consciousness, concern for acute glaucoma) in their history or physical examination warrant further investigation for secondary causes of headache. […] Patients with stable primary headache disorders (i.e., no red flags and normal neurologic examination) do not need neuroimaging. […] Migraine headache is classically underdiagnosed. Patients for whom a diagnosis of migraine should be considered include those with recurring sinus headaches or recurrent severe headaches with a normal neurologic examination.

• #10 Acute Headache in Adults: A Diagnostic Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/acute-headache-adults.html

  A detailed history and physical examination can distinguish between key features of a benign primary headache and concerning symptoms that warrant further evaluation for a secondary headache. […] Evaluating acute headaches using a systematic framework such as the SNNOOP10 mnemonic can help detect life-threatening secondary causes of headaches. […] Red flag signs or symptoms such as acute thunderclap headache, fever, meningeal irritation on physical examination, papilledema with focal neurologic signs, impaired consciousness, and concern for acute glaucoma warrant immediate evaluation. […] For emergent evaluations, noncontrast computed tomography of the head is recommended to exclude acute intracranial hemorrhage or mass effect. […] A lumbar puncture is also needed to rule out subarachnoid hemorrhage if the scan result is normal.

• #11 4.3 Primary headache associated with sexual activity – ICHD-3

  https://ichd-3.org/other-primary-headache-disorders/4-3-primary-headache-associated-with-sexual-activity/

  3. Either or both of the following: […] – increasing in intensity with increasing sexual excitement […] – abrupt explosive intensity just before or with orgasm […] 4. Lasting from 1 minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity […] 5. Not better accounted for by another ICHD-3 diagnosis. […] Notes: 4.3 Primary headache associated with sexual activity is not associated with disturbance of consciousness, vomiting or visual, sensory or motor symptoms, whereas symptomatic sexual headache may be. On the first onset of headache with sexual activity, it is mandatory to exclude subarachnoid haemorrhage, intra- and extracranial arterial dissection and reversible cerebral vasoconstriction syndrome (RCVS). […] Multiple explosive headaches during sexual activities should be considered as 6.7.3 Headache attributed to reversible cerebral vasoconstriction syndrome until proven otherwise by angiographic studies (including conventional, magnetic resonance or computed tomography angiography) or transcranial Doppler ultrasonography. Of note, vasoconstrictions may not be observed in the early stage of RCVS; therefore, follow-up studies may be needed.

• #12 What if the ‘sexual headache’ is not a joke? | British Journal of Medical Practitioners

  https://www.bjmp.org/content/what-if-sexual-headache-not-joke

  Headaches associated with sexual activity can be anything but a joke. HSA (headaches associated with sexual activity) are by definition benign conditions but the symptoms can be the same as in serious life threatening cerebral conditions and these need to be quickly excluded at the first presentation. […] HSA are capricious in nature with poorly understood pathophysiology and uncertain course of the condition. Patients need to have the situation clearly explained to them so that management can be optimal. […] A thorough history and neurological examination with the option of imaging studies and CSF examination must be conducted. Type 2 explosive thunderclap headaches can be secondary to subarachnoid haemorrhage, aneurysms without obvious rupture, intracerebral haemorrhage, pituitary apoplexy, venous sinus thrombosis, cervical artery dissection, subdural haematoma, haemorrhage into an intracranial neoplasm, cerebral tumour, intracranial hypotension and hypertension, significant cervical spine disease, and ischaemic stroke and these serious conditions need to be excluded before an HSA diagnosis can be given.

• #13 Primary headache associated with sexual activity | MedLink Neurology

  https://www.medlink.com/articles/primary-headache-associated-with-sexual-activity

  Sexually related headache may be primary or secondary. In this article, the author updates the discussion of primary headache associated with sexual activity. This headache can start as a dull bilateral ache with increasing sexual excitement or suddenly become intense with orgasm. Neuroimaging studies of both brain parenchyma and cerebral vasculature are recommended for all patients to exclude secondary causes. On the first onset, subarachnoid hemorrhage must be ruled out. Reversible cerebral vasoconstriction syndrome should be considered until proven otherwise in those with multiple attacks of sexual headache. […] Evaluation of new-onset headache associated with sexual activity should exclude secondary causes. […] Secondary causes of headache associated with sexual activity include subarachnoid hemorrhage, arterial dissection, stroke, and reversible cerebral vasoconstriction syndrome.

• #14 Approach to Acute Headache in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0515/p682.html

  Lumbar puncture is useful for identifying infection, the presence of red blood cells (which suggests bleeding), and abnormal cells associated with some CNS malignancies. […] In adults with suspected subarachnoid hemorrhage, it is important to perform lumbar puncture to check for blood or xanthochromia. […] A patient who reports the worst headache of his or her life, especially if the patient is older than 50 years, or who has a headache that occurs with exertion (including sexual intercourse) could be experiencing intracranial hemorrhage or carotid artery dissection. […] Prompt investigation is required for any headaches associated with neurologic findings, including changes in mental status, seizures, and visual disturbances.

• #15 Diagnosis and classification of headache associated with sexual activity using a composite algorithm: A cohort study – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34275353/

  To differentiate primary headache associated with sexual activity from other devastating secondary causes. […] In this prospective cohort, we recruited consecutive patients with at least 2 attacks of headache associated with sexual activity from the headache clinics or emergency department of a national medical center from 2005 to 2020. […] Our clinic-radiologic composite algorithm diagnosed and classified all patients into four groups, including 38 (15.5%) with primary headache associated with sexual activity, 174 (71.0%) with reversible cerebral vasoconstriction syndrome, 26 (10.6%) with probable reversible cerebral vasoconstriction syndrome, and 7 (2.9%) with other secondary causes. […] Our composite clinic-radiological diagnostic algorithm successfully classified repeated headaches associated with sexual activity, which were predominantly secondary and related to vascular disorders, and predicted the prognosis. Primary headache associated with sexual activity and reversible cerebral vasoconstriction syndrome presented with repeated attacks of headache associated with sexual activity may be of the same disease spectrum.

• #16 Get a Headache After Sex? An Expert Deciphers Sex Headaches — Migraine Again

  https://www.migraineagain.com/sex-headache/

  Getting a sudden headache during sex is inconvenient, at best, and can even be downright scary. If this has happened to you, you’re not alone; it’s more common than many realize. Learn about what a primary sex headache is, how it relates to migraine, and how to treat it. […] The International Classification of Headache Disorders (ICHD-3) refers to primary sex headache as „primary headache associated with sexual activity,” which is a headache that is brought on by and occurs only during sexual activity. The formal definition states that a sex headache is either or both of the following: Increasing intensity of head pain with increasing sexual excitement or arousal, and/or The abrupt, explosive intensity of head pain just before or with orgasm. […] Primary sex headache can be a short-term attack or it can last up to 24 hours. If the sex headache lasts up to 72 hours, the headache only has to be mild in intensity to qualify for the diagnosis. Primary sex headaches also don’t have the specific features of a migraine attack like light and sound sensitivity or nausea.

• #17 Headaches Associated With Sex Are No Joke

  https://www.neurologylive.com/view/headaches-associated-sex-are-no-joke

  In 2004, the International Headache Society classified headaches associated with sexual activity as a distinct form of primary headache, and the 2018 International Classification of Headache Disorders, Third Edition notes that it can be diagnosed with least 2 episodes of pain in the head and/or neck which are brought on by and occurring only during sexual activity, and either, or both, increase in intensity with increasing sexual excitement and are abruptly explosive in intensity just before or with orgasm. […] The ICHD-3 also notes that these headaches can last from 1 minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity, and often cannot be better accounted for by another ICHD-3 diagnosis. […] The following are the 3 main types of sex-related headaches: A dull ache in the head and neck that begins before orgasm and gets worse as sexual arousal increases. It is similar to a tension headache. An intensely painful headache that begins during orgasm and can last for hours. This so-called thunderclap headache grabs attention because it comes on like a clap of thunder.

• #18 4.3.1 Probable primary headache associated with sexual activity – ICHD-3

  https://ichd-3.org/other-primary-headache-disorders/4-3-primary-headache-associated-with-sexual-activity/4-3-1-probable-primary-headache-associated-with-sexual-activity/

  4.3.1 Probable primary headache associated with sexual activity […] Diagnostic criteria: […] Either of the following: […] a single headache episode fulfilling criteria B-D […] at least two headache episodes fulfilling criterion B and either but not both of criteria C and D […] Brought on by and occurring only during sexual activity […] Either or both of the following: […] increasing in intensity with increasing sexual excitement […] abrupt explosive intensity just before or with orgasm […] Lasting from 1 minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity […] Not fulfilling ICHD-3 criteria for any other headache disorder […] Not better accounted for by another ICHD-3 diagnosis.

• #19 4.3 Primary headache associated with sexual activity – ICHD-3

  https://ichd-3.org/other-primary-headache-disorders/4-3-primary-headache-associated-with-sexual-activity/

  Comments: Two subtypes (preorgasmic headache and orgasmic headache) were included in ICHD-I and ICHD-II, but clinical studies have since been unable to distinguish these; therefore, 4.3 Primary headache associated with sexual activity is now regarded as a single entity with variable presentation. […] Recent studies have shown that up to 40% of all cases run a chronic course over more than a year. […] Some patients experience only one attack of 4.3 Primary headache associated with sexual activity during their lives; they should be diagnosed as 4.3.1 Probable primary headache associated with sexual activity. For further research on this headache type, it is recommended to include only patients with at least two attacks. […] Epidemiological research has further shown that 4.3 Primary headache associated with sexual activity can occur at any sexually active age, is more prevalent in males than in females (ratios range from 1.2:1 to 3:1), occurs independently of the type of sexual activity, is not accompanied by autonomic or vegetative symptoms in most cases, is bilateral in two-thirds and unilateral in one-third of cases and is diffuse or occipitally localized in 80% of cases. Attack frequency of 4.3 Primary headache associated with sexual activity should always be related to the frequency of sexual activity.

• #20 Sex headaches – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sex-headaches/symptoms-causes/syc-20377477

  Any type of sexual activity that leads to orgasm can trigger sex headaches. […] Sex headaches associated with loss of consciousness, vomiting, stiff neck, other neurological symptoms and severe pain lasting more than 24 hours are more likely to be due to an underlying cause. […] Sex headaches can affect anyone. But risk factors for these headaches include: Being male. Men are more prone to having sex headaches. […] History of migraines. Being prone to migraines increases your risk of sex headaches. […] Sometimes sex headaches can be prevented by stopping sexual activity before orgasm. Taking a more passive role during sex also may help.

• #21 Headache Associated with Sexual Activity | SpringerLink

  https://link.springer.com/10.1007/978-88-470-1700-9_29

  Two entities are currently identified: headache occurring before orgasm and headache occurring during orgasm. Primary headache associated with sexual activity is more frequent in men than women (mean age: 40), and is more frequent in migraineurs. Preorgasmic headache is typically a bilateral pain, predominant in the occipital and cervical regions. It is described as a dull ache that increases progressively, typically intensifying as sexual excitement increases, and lasting a couple of hours to several days. This type of headache might be caused by an excessive tightening of the head and neck muscles during sexual activity. Orgasmic headache is the most common variety of sex headache. It usually gives no warning, as in thunderclap headache. Its duration is highly variable (from few minutes to 3 h, usually, but can last up to 48 h). This type of headache is usually isolated, but accompanying symptoms such as nausea, emesis, phonophobia, or photophobia can be found. Practically, this headache must be considered as a thunderclap headache. At first manifestation, a subarachnoid hemorrhage must be ruled out as a priority, and then other medical conditions, as preruptured aneurysm, arterial dissection (carotid, vertebral, or intracranial dissection), diffuse segmental vasoconstriction, bout of hypertension, and CSF hypotension. Once all conditions from the list above have been ruled out, the headache is considered as primary. It is essential to reassure the patient, and propose first nonmedicinal approaches (relaxation, biofeedback, even though scientific evidences are poor for such treatments). If necessary, beta-blockers (propranolol) or calcium-channel inhibitors (diltiazem) can be proposed. Taking indomethacin 30 min before sex could also be helpful.

• #22 Sex differences in the clinical manifestations related to dependence behaviors in medication-overuse headache | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01685-z

  The present study aimed to compare sex differences in the clinical manifestations related to dependence behaviors in medication-overuse headache (MOH). […] In particular, behaviors of substance dependence were reported to be present in up to two thirds of MOH patients. […] The Leeds Dependence Questionnaire (LDQ) and the Severity of Dependence Scale (SDS) are two neuropsychological instruments commonly used in the clinical studies of dependence behaviors in SUDs and in MOH. […] The aims of the present study were (1) to determine sex differences in the association between MOH and the current use of tobacco, alcohol, caffeine, or hypnotics, (2) to compare the diagnostic utilities of the LDQ and the SDS in the detection of MOH between women and men with CM, and (3) to evaluate between-sex differences in the clinical presentations of MOH.

• #23 Sex differences in the clinical manifestations related to dependence behaviors in medication-overuse headache | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01685-z

  The current study identified an association between smoking and MOH in men, as well as sex-specific cutoffs of the LDQ and the SDS, for MOH. […] In the entire study population, the cutoff score of the LDQ for a diagnosis of MOH was determined at 7, with a sensitivity of 75.7% and a specificity of 78.4%, and the cutoff score of the SDS was determined at 5. […] When women and men were analyzed separately, the cutoff scores of the LDQ for MOH were determined at 7 for women and 6 for men, and the cutoff scores for the SDS were 5 for women and 4 for men. […] In conclusion, the present study demonstrated differential risks of MOH associated with tobacco use between men and women and identified sex-specific cutoff scores of the LDQ and the SDS for MOH among patients with CM.

• #24 A CASE OF RECURRENT THUNDERCLAP HEADACHES ASSOCIATED WITH ORGASM – SHM Abstracts | Society of Hospital Medicine

  https://shmabstracts.org/abstract/a-case-of-recurrent-thunderclap-headaches-associated-with-orgasm/

  The patient was a 31-year-old healthy female who presented with acute onset headache reaching maximum severity within one minute (thunderclap) associated with sexual activity at the time of orgasm. […] RCVS is an uncommon but underdiagnosed syndrome marked by multifocal narrowing of cerebral arteries triggered by acute physiologic stress, often presenting with recurrent thunderclap headaches. […] In this case, the imaging and angiography findings were diagnostic, with vasoconstriction observed on CTA and MRA brain and subsequent resolution on DCA several days later, typical of RCVS. […] The differential included RCVS, primary angiitis of the central nervous system (PACNS), and primary sex headache. […] RCVS is an uncommon cause of thunderclap headaches but should be considered in a patient presenting with recurrent headaches triggered by physiologic stress without neurologic deficits.

• #25 Emergency Room Headache: A Case with Primary Thunderclap Headache Including Differential Diagnosis from Secondary Ones | Ento Key

  https://entokey.com/emergency-room-headache-a-case-with-primary-thunderclap-headache-including-differential-diagnosis-from-secondary-ones/

  A 41-year-old man was admitted to the general emergency room (ER) because of an extremely severe headache of instantaneous onset (1 min at most), probably the worst ever in his life. […] The patient was referred to the emergency headache centre (EHC) for appropriate investigations. […] Despite that all these studies were normal, it was decided to carry out a conventional angiography to rule out definitely a reversible cerebral vasoconstriction syndrome (RCVS). […] It is a severe high-intensity headache of abrupt onset; we must investigate with a detailed questionnaire: […] The patient must be urgently referred to an emergency department and if possible to a hospital with neurological department. […] The prevalence of sexual headache is unknown. […] The number of attacks per bout ranges from 2 to 50, and the mean duration of the symptomatic period is 3 months, though a minority of patients suffer from sexual headache for several years without apparent remission.

• #26 Headache Disorders: Differentiating Primary and Secondary Etiologies

  https://www.imrpress.com/journal/JIN/23/2/10.31083/j.jin2302043/htm

  Although most individuals are affected by primary headaches, the first mandatory step in the examination is the exclusion of secondary forms, considering the high risk to the patient’s life in most of them. […] The diagnosis of GCA is made primarily on clinical presentation and is supported by laboratory evidence of an acute phase reaction (such as elevated erythrocyte sedimentation rate). […] The diagnosis of a bAVM also relies heavily on imaging modalities. CT is very sensitive in detecting hemorrhage in light of new neurological deficits, namely CT angiography, raising suspicion for bAVM. […] When investigating diagnostic specifics, papilledema may be detected on ophthalmologic examination. […] A notable stipulation regarding the opening pressure is that physiological variation between individuals creates a “grey zone” for OP. That is, between 250–300 mm, for some this may be either physiological or pathological. Therefore, the clinical utility of the CSF OP is exceedingly reliant on other portions of the diagnostic workup, such as the history.

• #27 Frontiers | Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1373528/full

  Cluster headache (CH) is one of the worst primary headaches that remain underdiagnosed and inappropriately treated. […] This paper aims to review CH’s recent clinical and pathophysiological findings, diagnosis, and treatment. […] An MRI of the brain is mandatory to exclude secondary etiologies. […] In conclusion, CH remains underdiagnosed, mainly due to a lack of awareness within the medical community, frequently causing a long delay in reaching a final diagnosis. […] The clinical picture of CH and its diagnostic criteria are defined in the current version of the International Classification of Headache Disorders (ICHD-3) published by the International Headache Society (IHS). […] The diagnosis of CH is primarily clinical, and neuroimaging studies are indicated in specific cases to rule out secondary headaches.

• #28 Frontiers | Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1373528/full

  Frequently, there is a significant delay in diagnosing CH, which is essential when planning optimal medical management. […] When CH is misdiagnosed, the clinical picture is most confounded as migraine, either because the clinical picture is misinterpreted or because both headache disorders occur as comorbidity, which is then not recognized. […] The Erwin test is a tool that identifies patients with CH. […] In summary, an MRI of the brain with contrast is recommended in every patient with CH, an MRI of the sella turcica in suspected pituitary tumors and in patients with suspected cerebrovascular lesions, an angio-MRI or MRI of aortic trunks. […] Atypical features of CH that should alert the clinician are (1) pain attacks being exclusively ocular or retro-ocular, (2) abnormal findings on neurological examination, (3) other headache attacks between those typical of CH, (4) atypical duration of CH, (5) migraine-like symptoms, (6) Horner’s syndrome, and (7) an unexpected frequency of atypical attacks, being the most relevant, in particular cranial nerve disorders, within which ophthalmological signs and symptoms are the most frequent. […] Resistance to standard treatments for CH should increase the suspicion of a secondary origin.

• #29 Headache Disorders: Differentiating Primary and Secondary Etiologies

  https://www.imrpress.com/journal/JIN/23/2/10.31083/j.jin2302043/htm

  Spontaneous intracranial hypotension (SIH) is characterized by an incapacitating orthostatic headache syndrome cause by CSF leakage and the resulting diminished pressure of the subarachnoid space. […] The preferred treatment modality is surgery which may vary in the form access including endoscopically or through a more traditional craniotomy. […] The diagnosis of GCA is made primarily on clinical presentation and is supported by laboratory evidence of an acute phase reaction (such as elevated erythrocyte sedimentation rate).

• #30 Acute Headache in Adults: A Diagnostic Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0900/acute-headache-adults.html

  Primary headache onset after 50 years of age is uncommon, and onset after 65 years of age carries a high risk of a serious secondary etiology. […] In patients older than 50 years, giant cell arteritis must be considered. […] Neuroimaging and an additional evaluation may be necessary to exclude life-threatening causes of headaches when red flags are present. […] For emergent evaluations of headache, non-contrast computed tomography (CT) of the head is sensitive enough to exclude a new intracranial hemorrhage or mass effect. […] A lumbar puncture must follow a reassuring CT scan to sufficiently exclude subarachnoid hemorrhage. […] Brain magnetic resonance imaging (MRI) with and without contrast is the preferred method for evaluating headaches with other concerning features.

• #31 Diagnosing Headache | NYU Langone Health

  https://nyulangone.org/conditions/headache/diagnosis

  To determine the type of headache causing your pain, neurologists at NYU Langone ask about your headache history and symptoms, focusing on the frequency, intensity, duration, location, and any known triggers. […] Depending on your symptoms and the results of your medical and neurologic examinations, your physician may recommend further diagnostic testing. […] Your doctor may use one or more of the following tests to arrive at the most accurate diagnosis. […] A neurological examination may include an evaluation of your mental status, motor strength, vision, and reflex testing. […] Your doctor may order an MRI scan to view the inside of the head and neck. […] A magnetic resonance angiogram, or MRA, is similar to an MRI scan. […] NYU Langone specialists use the results of these tests, along with their clinical judgment and skills, to craft a treatment plan to alleviate your symptoms.

• #32 Diagnosing Secondary Headaches

  https://practicalneurology.com/diseases-diagnoses/child-neurology/diagnosing-secondary-headaches/31654/

  The SNOOP10 mnemonic is a useful framework for diagnosing secondary headaches. […] Secondary headaches are those in which the headache is a symptom of another disorder recognized as a potential underlying cause. […] Approximately 18% of people who experience a headache have a secondary headache disorder. […] Diagnosis of secondary headache disorders can be straightforward if a person with no prior headache history develops headache in the setting of a disorder known to cause headaches. […] Many laboratory and neuroimaging studies can be ordered for a suspected secondary headache. […] Therefore, detailed history taking, physical examination, and recognition of diagnostic red flags that may prompt appropriate secondary headache evaluation are crucial to diagnosis. […] The presence of atypical features or red flags raises concern for secondary headaches. […] The SNOOP mnemonic is a helpful approach to ensure that red flags are not overlooked.

• #33 Emergency Room Headache: A Case with Primary Thunderclap Headache Including Differential Diagnosis from Secondary Ones | Ento Key

  https://entokey.com/emergency-room-headache-a-case-with-primary-thunderclap-headache-including-differential-diagnosis-from-secondary-ones/

  Pain characteristics are also similar to those described for primary exertional headache. […] Patients with sexual headache are usually healthy people, with no vascular disease. […] A minority of patients experiencing cough headache due to Chiari type I malformation or some other posterior fossa abnormality also notice head pain during orgasm. […] A. At least two episodes of pain in the head and/or neck fulfilling criteria BD B. Brought on by and occurring only during sexual activity C. Either or both of the following: 1. Increasing in intensity with increasing sexual excitement 2. Abrupt explosive intensity just before or with orgasm D. Lasting from 1 min to 24 h with severe intensity and/or up to 72 h with mild intensity E. Not better accounted for by another International Classification of Headache Disorders (ICHD-3) diagnosis.

• #34 Approach to Acute Headache in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0515/p682.html

  For most other dangerous causes of headache, magnetic resonance imaging or computed tomography is acceptable. […] Most headache diagnoses are based entirely on the patient history. […] The International Headache Society has published a system of classification and operational diagnostic criteria for headache based on clinical consensus. […] Patients with a history of headache who do not have red flag signs and symptoms are at low risk of serious headache. […] Additionally, they should have primary headache characteristics. […] Patients at low risk of serious headache do not require neuroimaging. […] Neuroimaging is indicated for all patients who present with signs or symptoms of dangerous headache, because they are at increased risk of intracranial pathology. […] Although considerable debate exists about the optimal way to perform neuroimaging for acute headaches, the American College of Radiology has made a few specific recommendations.

• #35 Debunking myths in headache diagnosis for the pain practitioner | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/49/8/545

  With headache being one of the most common chief complaints, it is essential for pain practitioners to interpret and differentiate a variety of headache characteristics to accurately diagnose and treat specific headache disorders. […] This article presents and discusses six myths about several common headache disorders (migraine, tension-type headache, cluster headache, cervicogenic headache, sinus headache, and occipital neuralgia) often encountered in clinical practice. […] Recognizing and understanding the intricacies behind key headache diagnoses will help providers devise appropriate plans to better care for their patients. […] Pain doctors frequently encounter headaches in practice. The International Classification of Headache Disorders, 3rd edition offers a guide to identify different headache disorders. Misconceptions are common with several headache disorders.

• #36 Orgasm Headache: Causes, Treatment, and More

  https://www.healthline.com/health/healthy-sex/orgasm-headache

  Orgasm headaches are typically benign. But some additional symptoms may indicate a more severe condition. […] What causes a sex headache? […] A sexual benign headache happens because the increase in sexual excitement causes the muscles to contract in your head and neck, resulting in head pain. A orgasm headache, on the other hand, occurs because of a spike in blood pressure that causes your blood vessels to dilate. […] How are sex headaches diagnosed? […] After assessing your symptoms, your doctor will perform a series of tests to rule out any neurological issues. […] You should see your doctor if its your first-ever sex headache or if it begins abruptly. […] Although an orgasm headache is usually nothing to worry about, you should still make sure there isnt anything more serious going on.

• #37 Headaches Associated With Sex Are No Joke

  https://www.neurologylive.com/view/headaches-associated-sex-are-no-joke

  A headache that occurs after sex and can range from mild to extremely painful. This headache gets worse when the patient stands and lessens when the patient lies back down. […] Biller said men are 3 to 4 times more likely to get headaches associated with sexual activity than women. Depending on the type of headache, medications can help relieve the pain or even prevent the headache, he said. […] To reduce the risk of headaches associated with sexual activity, doctors should counsel patients to exercise regularly, avoid excessive alcohol intake, maintain a healthy weight and, if necessary, seek counseling, Biller said. […] We recommend that patients undergo a thorough neurological evaluation to rule out secondary causes, which can be life-threatening, Biller said. This is especially important when the headache is a first occurrence.

• #38 What Is Headache? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/headache/guide/

  Blood and Urine Tests Blood and urine tests may be ordered to look for infection and other health conditions of which headaches are a symptom. […] Whenever possible, the underlying cause of a secondary headache should be treated; for example, if the headache is caused by an infection, the infection should be treated, per the Sepsis Alliance.

• #39 Secondary Headache: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/migraines-headaches/secondary-headaches

  It can be tricky to tell primary and secondary headaches apart. […] To diagnose you, the doctor will first ask you lots of questions. Then theyll check your vital signs. This includes your blood pressure, heart rate, temperature, and weight. Theyll also look into your eyes. Next, theyll do a neurological exam of your head, neck, and nervous system. Theyll also look to see if your muscles are strong and reflexes are normal. […] Your doctor might also do: Blood tests: These can check for other conditions […] Imaging tests: They might include: Sinus X-rays: To check for congestion […] Magnetic resonance imaging (MRI): To make a picture of the inside of your brain […] Computed tomography scan (CT scan): This also creates an image of your brain. […] Other tests may include bloodwork to rule out other conditions or a spinal tap to look for signs of infection or bleeding around your brain.

• #40 Throbbing Headache: Causes and Treatment

  https://www.webmd.com/migraines-headaches/throbbing-headache-causes

  Urine (pee) and blood tests, to look for infections. […] Checking the fluid around your spinal cord and brain since abnormal amounts of pressure can cause headaches. […] Imaging tests, such as a CT or MRI scan, can spot areas of damage in your brain tissue or blood vessels. […] Electroencephalogram (EEG), which measures your brain waves and can check for issues such as inflammation, head trauma, and tumors. […] […] […] Sex […] Rarely, having sex can bring on a headache. It may start as a mild ache in your head or neck, then get more intense. Or you could begin to have throbbing pain around the time that you orgasm. […] Headaches associated with sexual activity (HAS) usually happen because you’re doing a lot of sudden physical activity. They can happen to anyone but are more common if you’re assigned male at birth (AMAB.)

• #41 Headache Types – Headache Disorders & Diagnosis

  https://nationalheadacheinstitute.com/disorders/

  Our medical professionals take the time to carefully explore the cause and condition of each patient’s headaches so we can ensure we prescribe the correct treatment. […] It is important to differentiate among the types of headaches in question, whether primary or secondary. This is done by conducting a thorough neurological examination and complete patient history. […] Answers To The Following Questions Will Guide The Diagnosis of Headache Types: […] Secondary headache disorders will often include signaling items in the patient history and examination results that will alert the physician to evaluate further. […] Headaches brought on by sneezing, coughing, sex or exertion (Headaches of this nature can be primary OR secondary. Aneurysm should be ruled out before determining that the headache is a primary rather than secondary.)

• #42 Get a Headache After Sex? An Expert Deciphers Sex Headaches — Migraine Again

  https://www.migraineagain.com/sex-headache/

  As a result, it’s thought that they occur more commonly in those with migraine. But they are also seen in individuals who haven’t had a previous history of migraine. […] Any kind of headache attack that comes on very suddenly, where it reaches maximal pain intensity within seconds, is one where healthcare practitioners are concerned about potential vascular causes or increased brain pressure. The first time a primary sex headache happens, it’s important to seek medical advice and consider evaluation by a healthcare provider to rule out secondary vascular causes or other causes. […] There are some red flags that would point toward going to the emergency department. Having a stiff neck or back pain can be a sign that there is something more serious that needs an emergent evaluation. […] Also, a fever would be a red flag that warrants urgent evaluation. Another reason would be if the headache persists at a severe level for more than a couple of hours; this would be an indication to get in touch with a healthcare provider and consider going to an emergency department.

• #43 Sex headaches – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sex-headaches/symptoms-causes/syc-20377477

  In rare instances, headaches can be brought on by sexual activity especially with orgasm. […] Most sex headaches are nothing to worry about. But some can be a sign of something serious, such as problems with the blood vessels that feed the brain. […] There are two types of sex headaches: A dull ache in the head and neck that intensifies as sexual excitement increases and A sudden, severe, throbbing headache that occurs just before or at the moment of orgasm. […] Most sex headaches last at least several minutes. Others may linger for hours or even 2 to 3 days. […] Sex headaches aren’t usually a cause for concern. But consult your health care provider right away if you experience a headache during sexual activity especially if it begins abruptly or it’s your first headache of this type.

• #44 Get a Headache After Sex? An Expert Deciphers Sex Headaches — Migraine Again

  https://www.migraineagain.com/sex-headache/

  Talk about primary sex headaches with your healthcare provider. Some people are uncomfortable talking about sex, but it is an important topic for many reasons. […] No. 1, it’s treatable and No. 2, it is, generally speaking, self-limited and will eventually go away. It’s also important to consider the possibility with your healthcare provider, even though it’s a small possibility, that there is some other more serious underlying cause of a headache associated with sexual activity. […] One other point is that medications that are used for sexual dysfunction like those with the brand names Viagra (sildenafil) or Cialis (tadalafil) can trigger a migraine attack. So that’s something to keep in mind for those who are using those products. […] Primary sex headaches are more common than many realize and can be both inconvenient and scary. These headaches occur only during sexual activity and can be characterized by increasing intensity with sexual excitement or a sudden, explosive intensity just before or with orgasm.

• #45 Get a Headache After Sex? An Expert Deciphers Sex Headaches — Migraine Again

  https://www.migraineagain.com/sex-headache/

  While the exact cause is not fully understood, it is believed to be related to the release of specific chemicals during sex. Treatment options for primary sex headaches include pretreatment with indomethacin, which is often effective in preventing these headaches. […] It is also important to rule out any underlying secondary causes and to discuss the issue with a healthcare provider. Although primary sex headaches can be uncomfortable and disabling, they often resolve with repeated sexual activity. […] It is worth noting that primary sex headaches are not well documented in terms of epidemiology, but they are commonly seen by headache specialists, particularly in individuals with a history of migraine. Additionally, some individuals with migraine have reported that sex or orgasm can relieve their migraine symptoms, possibly due to a surge in autonomic activity or the release of certain chemicals.

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