Although primary exertional headache and primary headache associated with sexual activity, orgasmic-type are separately classified headache types, they may be variations of the same disorder.
WASHINGTON, DC—Two-thirds of patients with orgasmic headache also experience exertional headache, according to research presented at the 53rd Annual Scientific Meeting of the American Headache Society. Investigators also found that preemptive treatment with indomethacin resulted in a headache-free response for both conditions.
Ira M. Turner, MD, and colleagues from the Center for Headache Care and Research Island Neurological Associates in Plainview, New York, performed an analysis of medical records which suggested that the two headache disorders are more similar than previously thought. “Although primary headache associated with sexual activity, orgasmic-type and primary exertional headache are classified as separate and distinct headache disorders, they have many similar characteristics,” the researchers wrote. “When specifically questioned, patients who are evaluated for orgasmic headaches often admit to experiencing headaches with exertion.”
Overlapping Disorders
The objective of the study, according to the authors, was “to review the degree of overlap of these two relatively uncommon headache disorders, in terms of coexistence and response to preemptive treatment with indomethacin.” According to the ICHD II, primary exertional headache is headache precipitated by any form of exercise; primary headache associated with sexual activity, orgasmic type is defined as headache precipitated by sexual activity, in the absence of any intracranial disorder.
The investigators analyzed the medical records of all patients diagnosed with orgasmic headache to determine if any of the patients also met criteria for other headache disorders, including primary exertional headache, primary thunderclap headache, and migraine with or without aura. All patients also underwent imaging studies to confirm that secondary causes of headache were excluded.
“A total of 15 patients were identified who were seen during this two-year period for primary headache associated with sexual activity, orgasmic-type,” the authors reported. “Ten of these 15 patients (eight males) also fulfilled criteria for primary exertional headaches.” In addition, four met criteria for primary thunderclap headache, and seven met criteria for migraine with or without aura.
Preemptive Treatment Yields Headache-Free Results
Of the 15 patients who had primary headache associated with sexual activity, six patients (four males) preemptively treated their headaches with 50 mg indomethacin.
“All patients had a headache-free response upon orgasm,” the researchers stated. “Likewise, three patients who took indomethacin for exertional headache had a headache-free response.” Those patients who had taken indomethacin discontinued their treatment after the maximum time period of three months; all reported remaining headache-free.
“All patients who treated either headache type with indomethacin achieved a headache-free response,” Dr. Turner and colleagues concluded. “It appears these two separately classified headache types have much in common and may be variations of the same headache disorder.”
—Ariel Jones