The primary objective of this study was to describe characteristics of patients diagnosed with Headache Associated with Sexual Activity at our institution to address the appropriateness of their evaluation and treatment for this condition. 

Headache associated with sexual activity is a rare condition affecting roughly 1% of the population. This diagnosis is likely to be underreported and undertreated due to sensitivity and potential embarrassment. Clinicians should be aware of this diagnosis and its evaluation. As a primary headache it is benign and can resolve with appropriate treatment, but similar symptoms can be a warning of intracranial pathology. Anxiety about this headache's significance and avoidance of sexual activity are common. 

We identified 205 patients who had been seen between 1990 and 2018 with diagnosis of headache associated with sexual activity. We analyzed their demographics. We researched currently recommended therapies and their implementation in these headaches.We looked at appropriate workup using neuroimaging.

205 patients had a diagnosis of headache related with sexual activity (HSA). In our data set the prevalence was only 0.0068%, suggesting significant under-reporting and under-diagnosis.  There was a male preponderance with a ratio of 1.5 : 1.There was a high rate of comorbidity of HSA with migraine (29%) and tension type headache (8.3%). Only 2% patients received first-line treatment of verapamil, while indomethacin was used in 14.6%, beta blockers in 6.8%, and triptans in 8.2%. Most patients appear to have been under-treated.

Headache associated with sexual activity is under-recognized and under-diagnosed.  It is important in these patients to rule out intracranial pathology. Treatment is not consistently evidence-based, especially for patients who are seen in the emergency department or in primary care.  We recommend a screen for this condition in all patients presenting with headache, since comorbidity with other headaches is high and patients often do not spontaneously report symptoms.