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Headache associated with sexual activity

Demography, clinical features, and comorbidity

From the Department of Neurology (Drs. A. Frese, K. Frese, Schwaag, Husstedt, and Evers), University of Münster; and Department of Neurology (Dr. Eikermann), University of Essen, Germany.

Address correspondence and reprint requests to Dr. Achim Frese, Department of Neurology, University of Münster, Albert-Schweitzer Str. 33, D-48129 Münster, Germany; e-mail: fresea{at}uni-muenster.de

Objectives: To provide data on the demography, clinical features, and comorbidity of headache associated with sexual activity (HSA).

Methods: Between 1996 and 2001, 51 patients with the diagnosis of HSA were questioned using a structured interview.

Results: The mean age at onset was 39.2 (±11.1) years. There was a clear male preponderance (2.9:1). The age at onset had two peaks, with a first peak between the 20th and 24th (n = 13) years of life and a second peak between the 35th and 44th (n = 20) years of life. Eleven patients had HSA type 1 (dull subtype), which gradually increased with increasing sexual excitement. The remaining (n = 40) had HSA type 2 (explosive subtype). The pain was predominantly bilateral (67%), and diffuse or occipital (76%). The quality was nearly equally distributed among dull, throbbing, and stabbing. HSA was not dependent on specific sexual habits and most often occurred during sexual activity with the usual partner (94%) and during masturbation (35%). There was a high comorbidity with migraine (25%), benign exertional headache (29%), and tension-type headache (45%). HSA types 1 and 2 did not significantly differ in demography, clinical features, or comorbidity, except for a higher probability of stopping the attack by breaking off sexual activity in HSA type 1. There were no cases with HSA type 3 (postural subtype).

Conclusion: Mean age at onset, a male preponderance, a predominantly bilateral and occipital pain, and a high comorbidity with other primary headaches are in concordance with case reports in the literature. The authors found two peaks for the age at onset, however. There was no clinical evidence proving subtypes 1 and 2 to be distinct disorders. HSA types 1 and 2 may be different manifestations of the same disease rather than distinct entities.

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