From the Guidelines
The management of orgasmic headaches should prioritize preventive treatment with beta blockers, such as propranolol, as first-line medications, considering the patient's frequency of headaches and impact on quality of life 1. When considering treatment options, it's essential to evaluate the frequency and severity of the headaches, as well as their impact on the patient's daily life and relationships.
- Key factors to consider include:
- Frequency of headaches: If headaches occur frequently, daily prophylactic medications may be recommended.
- Severity of headaches: If headaches are severe, immediate relief measures such as NSAIDs or triptans may be necessary.
- Impact on quality of life: If headaches significantly impact the patient's relationships or daily activities, preventive treatment should be considered. The use of beta blockers, such as propranolol, as first-line medications is supported by recent guidelines, which recommend their use in patients who are adversely affected by migraine on ≥2 days per month despite optimized acute treatment 1. Additional treatment options, such as topiramate or candesartan, may be considered as first-line medications, while flunarizine, amitriptyline, or sodium valproate may be used as second-line medications 1. It's crucial to work with a healthcare provider to develop a personalized treatment plan, taking into account the patient's medical history, lifestyle, and specific needs.
- Non-pharmacological approaches, such as staying well-hydrated, avoiding sexual activity when fatigued or stressed, and practicing relaxation techniques, may also be beneficial in reducing the occurrence of orgasmic headaches.
From the Research
Management of Orgasmic Headaches
The management of orgasmic headaches, also known as primary headache associated with sexual activity (PHASA), involves a combination of preventive and acute treatments.
- Preemptive treatment with indomethacin and triptans administered prior to sexual activity can be effective in managing PHASA 2.
- Prophylactic treatment with beta-blockers, topiramate, and calcium channel blockers can also be used to reduce the frequency and severity of PHASA 2.
- CGRP-targeted therapies may provide relief in PHASA, although more research is needed to confirm their efficacy 2.
Treatment Options
Other treatment options for PHASA include:
- Amitriptyline, divalproex, topiramate, and beta-blockers, which have been shown to be effective in preventing migraine headaches and may also be beneficial for PHASA 3.
- New medication devices, such as intracutaneous, microneedle systems and breath-powered powder sumatriptan intranasal treatment, may also be effective in treating PHASA 4.
- Antibodies to CGRP and its receptor are being developed for migraine prevention and may also be beneficial for PHASA 4.
Importance of Proper Diagnosis
It is essential to conduct a thorough workup, including imaging, to rule out potentially life-threatening etiologies such as subarachnoid hemorrhage, reversible cerebral vasoconstrictive syndrome (RCVS), vasospasm, and dissection 2.
- A proper diagnosis is crucial in determining the most effective treatment plan for PHASA.
- Patients with PHASA often have comorbid conditions, such as migraine, tension-type headache, exertional headache, and hypertension, which should be taken into account when developing a treatment plan 2.