Primary headache associated with sexual activity (PHASA) is uncommon and can resemble serious secondary causes such as subarachnoid haemorrhage or reversible cerebral vasoconstriction syndrome. We report a 47-year-old woman with a history of migraine with aura who developed thunderclap headaches exclusively at orgasm after her transdermal oestradiol dose was increased from 50 µg to 75 µg twice weekly. Neuroimaging was normal. She also noticed a significant increase in libido during the higher dose period.
Discussion
Both the headaches and libido changes resolved after reducing oestradiol to 50 µg. Clinicians should consider HRT as a potentially reversible trigger in PHASA.
FreseAEikermannAFreseK, et al.Headache associated with sexual activity: demography, clinical features, and comorbidity. Neurology2003; 61(4): 796–800.
2.
LinPTChenSPWangSJ. Update on primary headache associated with sexual activity. Cephalalgia2023; 43(2): 205–214.
3.
Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd ed.Cephalalgia2018; 38(1): 1–211.
4.
AegidiusKLZwartJ-AHagenK, et al.Hormone replacement therapy and headache prevalence in postmenopausal women. The Head‐HUNT study. Eur J Neurol2007; 14(1): 73–78.
5.
NappiRECagnacciAGranellaF, et al.Course of primary headaches during hormone replacement therapy. Maturitas2001; 38(2): 157–163.
6.
DucklesSPKrauseDN. Cerebrovascular effects of estrogen: multiplicity of action. Clin Exp Pharmacol Physiol2007; 34(5): 801–808.
7.
MaynardPPaceA. Primary headache associated with sexual activity: a review of the literature. Curr Pain Headache Rep2024; 28(7): 627–632.
8.
AshkenaziASilbersteinSD. Hormone-related headache: pathophysiology and treatment. CNS Drugs2006; 20(2): 125–141.
9.
ChenWChuMLinY. Sexual behaviour and satisfaction in headache associated with sexual activity: a systematic review. Adv Sex Med2017; 7: 65–81.
