Epicrania fugax (EF) is a primary headache whose main feature is the dynamic character of the pain. EF pain typically moves across different dermatomes in a linear or zigzag trajectory.
Headache associated with sexual activity has been referred to as sexual headache, benign vascular sexual headache, coital cephalalgia, coital headache, intercourse headache, (pre)orgasmic cephalalgia, and (pre)orgasmic headache. Orgasmic headache presenting as epicrania fugax on left side is rare.
48 years male presented with acute onset linear trajectory shaped headaches radiating anteriorly from back of head only when he reaches peak of his sexual activity, and this headache is persists 1-2 hours, partially relieved with analgesic, but soreness persisting over that area, no vomiting. This has been there since last 2 months, examination normal, BP 130/90mmhg CTSCAN HEAD NORMAL, MRI BRAIN AND ANGIO NORMAL, Patient started on beta blocker and gabapentin and pain was relieved.
This is a rare case of sexual headaches presenting as epicrania fugax, EF essentially consists of brief paroxysms of pain describing a linear or zigzag trajectory across the surface of one hemicranium, commencing and terminating in the territories of different nerves. The pain of forward EF originates in a particular area of the occipital, parietal or temporal regions and moves anteriorly, whereas the pain of backward EF originates in the frontal area, the eye or the nose and moves posteriorly. Onset and termination points remain constant in each patient, with the pain strictly unilateral, although some patients have shifting sides. This combination of sexual headache with epicrania character is rare and could be attributed to haemodynamic changes.
This is a rare combination of headaches; sexual headaches may present differently but this is unique.
1. Epicrania fugax: 19 cases of an emerging headache Cuadrado ML Headache. 2013
2. Epicrania Fugax. Cuadrado ML, Guerrero AL, Pareja JA. Curr Pain Headache Rep. 2016