Orgasmic and Exertional Headaches: The Same or Different?

Although orgasmic headaches and Exertional headaches are two separately classified disorders, they have many similar characteristics. This led a recent study to review the degree of overlap of these two relatively uncommon primary headache disorders in terms of coexistence, symptomatology, and response to treatment with indomethacin, a medicine to which both conditions are known to frequently be responsive to. For the study the records from a headache care and research center were queried for all patients with headaches associated with sexual activity, orgasmic-type. These patients were then retrospectively reviewed to see how many of their headaches also met IHS criteria for primary Exertional headaches, primary thunderclap headaches, and migraine with or without aura. The patient’s responsiveness to pretreatment with indomethacin was also reviewed. A total of 15 patients met the criteria for primary headache associated with sexual activity, orgasmic-type. Of these 15 patients, 10 also fulfilled the IHS criteria for primary exertional headaches, 4 met the criteria for primary thunderclap headaches, and 7 had a history compatible with migraine with our without aura. All patients diagnosed with primary headache associated with sexual activity, orgasmic-type, responded well to pretreatment with indomethacin, as did all who treated preemptively for primary exertional headaches. The study concluded that 66.7% of patients seen for primary headaches associated with sexual activity, orgasmic-type also fulfilled the IHS criteria for primary exertional headaches, and all who treated preventively with indomethacin responded well. This led the authors of the study to assert that because these two unusual headache types appear to have much in common; it is conceivable that they may actually be two slight variations of the same underlying disorder. The relationship between orgasmic-type headaches and exertional headaches warrants further research.