Remission of Primary Headache Associated With Sexual Activity in a Woman After Chiropractic Spinal Manipulation: A Case Study

Autonomic dysfunction in a patient with primary headache associated with sexual activity: case report and literature review

BACKGROUND

Primary headache associate with sexual activity (PHASA) is a relatively rare clinical condition and characterized by thunderclap headache exclusively triggered by sexual activity. The suggested involvement of autonomic dysfunction with altered cerebrovascular tone may contribute to the underlying mechanism of PHASA. However, the utilization of head-up tilt test (HUT), a valuable tool for assessing autonomic function, has not been employed in patients with PHASA.

CASE PRESENTATION

We present a typical case of PHASA with positive HUT response.

CONCLUSION

Autonomic dysfunction and compensatory vasodilation due to cerebrovascular autoregulation may be part of the mechanism of PHASA.

Headache Associated with Sexual Activity-A Narrative Review of Literature

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. Migraine, hypnic headache or hemicrania continua have been reported to co-occur with HAWSA, but their common pathophysiologic basis is still unknown. Recent advances in the treatment of HAWSA include the introduction of topiramate, progesterone, and treatments such as greater occipital nerve injection, arterial embolization, and manual therapy. Whether these new therapeutic options will stand the test of time remains to be seen.