Valenca MM, Valenca LP, Bordini CA, da Silva WF, Leite JP, Antunes-Rodrigues J, Speciali JG. Cerebral vasospasm and headache during sexual intercourse and masturbatory orgasms Headache. 2004 Mar;44(3):244-8.
BACKGROUND: The pathophysiology of the explosive type of headache associated with sexual activity is not completely understood. Five reported cases ofpatients with thunderclap headache, precipitated by sexual activity, in associationwith concomitant cerebral arterial narrowing, were found in the literature.METHODS: A 44-year-old woman with both coital and masturbatory headachesduring orgasm associated with segmental reversible cerebral artery vasospasmwas investigated. Cerebral anatomy and eventual spasm was documented by magneticresonance imaging or digital angiography before, during, and after resolutionof the orgasmic headache-vasospasm clinical manifestation. CONCLUSION: Findingsof cerebral arterial narrowing, presented by some patients shortly afterorgasmic headache attacks, support the hypothesis that segmental vasospasmmay exert a role in the pathogenesis of this uncommon type of headache. Theliterature is reviewed, and possible mechanisms underlying the developmentof orgasmic headache are discussed.
Linn FH, Wijdicks EF. Causes and management of thunderclap headache:a comprehensive review. Neurologist. 2002 Sep;8(5):279-89.
BACKGROUND: Thunderclap headache (or sudden severe headache) is an uncommon type of headache. Recognition and accurate diagnosis of this headache areimportant, because there is often a serious underlying brain disorder. SUMMARY:In this article, causes and management of thunderclap headache are discussed.In the primary care setting, there is a serious cause in one third of patients,but in the hospital setting, up to two thirds of patients have a seriousunderlying brain disorder. Clues in history and physical examination canpoint to a possible serious underlying cause of thunderclap headache, suchas subarachnoid hemorrhage, intracranial hematoma, or cerebral venous thrombosis.The remaining patients with thunderclap headache, however, have a primaryheadache disorder, such as migraine or (less frequently) tension headachewith an unusual sudden onset, exertional headache, coital headache, coughheadache, or cluster headache. The concept of thunderclap headache as a distinctclinical entity is discussed, with implications for its evaluation. Presentradiological techniques are reviewed with regard to their diagnostic utilityin detecting a serious brain disorder. CONCLUSIONS: Thunderclap headacheis an uncommon type of headache, and a serious underlying cause should beexcluded.
Camargo ACS, Severe Headache May Signal Clot in Brain Vein, American Stroke Association’s 26th International Stroke Conference , 2001 Feb
The controversial relations between migraine and vascular headache on one hand, epilepsy on the other hand are once more discussed: survey of the arguments for a more than fortuitous connection, taken from literature and general experience. Critical analysis of the personal case material. Discussion of some specific groups of patients with various combinations of both syndromes: long antecedents of headaches, leading up to sporadic epileptic attacks, focal or generalized; clinical seizures under photic stimulation (10% of the cases with chronic headaches without organic lesions); headaches in the latency period of symptomatic epilepsy; cases ofseeming transition between the two syndromes; headaches as a substitute, anaura or as a component of the epileptic seizure, with clearly distinctive features between generalized and focal epilepsy: in patients with bilateral EEG paroxysms, headaches are usually diffuse or bilateral, in those with epileptogenicfoci, headaches, if consistently localized, are always reported to be homolateralto the focus. Considerations concerning pathogenesis include the familiarhypothesis of hypoxic discharges following migrainous vasoconstriction, aswell as secondary vascular headaches induced by focal epileptic activity. Headaches caused by excessive discharges in the sensory representation areas (H. Jackson) must be rare. Whether increased neuronal activity in the hypothalamus may be responsible for the migraine syndrome (Herberg), possibly in connection with biogenic amines, remains in open question.
A severe headache can indicate a stroke, but it could signal a lot of other things too. Research presented today at the American Stroke Association’s 26th International Stroke Conference may help doctors tell the difference between a headache or migraine and a rare stroke called cerebral venous thrombosis (CVT). The American Stroke Association is a division of the American Heart Association.
Researchers at the University of San Paulo, Brazil have pinpointed some characteristics of headaches that indicate a CVT - the formation of a blood clot in a vein of the brain. While most clotsoccur in arteries (which carry blood from the heart to the rest of the body)blood clots in a vein (which carries blood to the heart) is an infrequentcondition.
CVT is often difficult to diagnose becauseindividuals may experience a wide range of symptoms including headaches, seizuresor visual impairments. Symptoms can occur suddenly or progress for weeks.
"It is particularly important to recognize this condition early before the clot may spread in the cerebral venous system leading to other neurological complications such as - seizures, visual or motor deficits and increase of intracranial pressure," says lead researcher írica C.S. de Camargo, M.D.
Headache is frequently the first symptom reported by patients arriving in emergency rooms. The Brazilian study aimed to identify the specific characteristics of CVT-related headache to help differentiateCVT from other conditions.
Thirty-nine patients (69 percent female, average age 35 years) were evaluated from March 1996 to June 2000. They were confirmed to have CVT by magnetic resonance imaging and/or angiography. Pertinent headache information such as location, severity and duration was recorded on a standardized form.
Seventy-four percent of patients with headaches also had weakness, sensory deficits, visual impairments or nausea. Most of the headaches were limited to one side of the head (63 percent) and pulsated (49 percent). Pain worsened with head movement (31 percent), physical activity (23 percent) and coughing or sneezing (20 percent).
Headache onset occurred within 48 hours before seeking medical treatment in 26 percent of patients, while 54 percent of patients reported having chronic headaches for more than 30 days.
Headache was the most common symptom (84.6 percent) given for seeking medical care among those studied. But almost half those individuals had experienced headaches before, which may have delayed a correct diagnosis.
Another finding was the presence of "thunderclap" headaches described as very severe and sudden headaches in 11.4percent of patients and higher cerebrospinal fluid pressures in these patientsas compared to those with severe, but not thunderclap, headaches.
The researchers found that in some CVTpatients headaches may be sudden and severe mimicking subarachnoid hemorrhage -- a type of stroke characterized by a blood vessel bleeding into the small space between the membranes surrounding the brain -- or chronic migraine.
In individuals with prior headaches, changes in the characteristics of the headache as well as the presence of neurological signs are important clues to diagnosis, researchers say.
"An accurate diagnosis means patients can receive optimal treatment, including prompt anticoagulant therapy to managethe blood clot, which improves outcomes," says Camargo.
Camargo acknowledges that the small sample size of this study and lack of a control group make the results less generalizable, but believes CVT is underecognized and should be included inthe diagnosis of headache in the emergency room. A larger ongoing international study is underway.
ShiyamaA, Jacobson KM, Baloh RW, Migraine and benign positional vertigo Ann Otol Rhinol Laryngol, 2000 04, 109: 4, 377-80
Because inner ear symptoms are common in patients with migraine, we questioned whether benign positional vertigo (BPV) is more common in patients with migraine than in the general population. We reviewed the records of 247 patients seen in our neurology clinic over the past 5 years with a confirmed diagnosis of BPV. Each patient had the typicalhistory of BPV, and in each case the characteristic torsional vertical positioningnystagmus was identified. All were interviewed regarding migraine symptomsby means of standard International Headache Society criteria. Migraine was3 times more common in patients with BPV of unknown cause than in those withBPV secondary to trauma or surgical procedures. Most patients were cured withthe particle repositioning maneuver, regardless of the cause. Presumably, patients with migraine suffer recurrent damage to the inner ear (due to vasospasm or some other mechanism) that predisposes them to recurrent bouts of BPV.
Kruszewski P, Bieniaszewski L, Neubauer J, Krupa Wojciechowska B, Headache in patients with mild to moderate hypertension is generally not associated with simultaneous blood pressure elevation. J Hypertens, 2000 04, 18: 4, 437-44
OBJECTIVE: Although headache is regarded a symptom of hypertension, its relation to blood pressure, especially in mildand moderate hypertension, is not clear. Thus, the aim of the study was toinvestigate whether headache in patients with mild to moderate hypertension may be attributed to simultaneous elevations in blood pressure. DESIGN AND METHODS: Ambulatory blood pressure monitoring (ABPM) was performed in patients (mean age 48 +/- 10 years, n = 150, 92 men, 58 women) classified, according to their office blood pressure, as stage 1 -2 hypertensives (JNC VI). Headache periods were recorded in patients' diaries. RESULTS: Headaches were generally not directly associated with blood pressure elevations in the studied group of stage 1-2 hypertensive patients because (i) blood pressure values from headache periods were not significantly higher than those from headache-free periods; (ii) blood pressure values directly preceding the pain were not significantlydifferent from values at the beginning of headache; and (iii) in the vastmajority of hypertensives, their maximal blood pressure values were recordedduring headache-free periods. Moreover, in some instances, patients who showedmaximal ABPM values during headache had relatively high blood pressure, i.e.> or = 180/110 mmHg. CONCLUSIONS: Our results did not support the opinionthat headache experienced by stage 1-2 hypertensives was generally causedby simultaneous elevation in blood pressure. The direct mechanisms of headachein hypertension, as well as the relation between increments in blood pressureabove 180/110 mmHg and headache, need further investigations.
Silberstein SD, Niknam R, Rozen TD, Young WB, Cluster headache with aura.
Neurology, 2000 00, 54: 1, 219-21
Cluster headache with aura is rare. The authors retrospectively reviewed 101 cluster headache patient charts atthe Jefferson Headache Center. Six patients had an associated aura, five visualand one olfactory, lasting 5 to 120 minutes. Only one had migraine (withoutaura). Auras always occurred with or were followed by a severe cluster headache.Two patients were related.
Atherton WW, Kettner NW, The Empty Sella Journal of Manipulative and Physiolgical Therapeutics. 1999 Sep; 22(7): 478-82
Objective: To discuss the diagnostic imaging findings of an empty sella in a chiropractic patient with emphasis on magnetic resonance imaging (MRI) of normal and abnormal pituitary appearances. Clinical Features: A 44-year-old woman started having headache, dizziness, nausea, vomiting, and diarrhea after an argument with her boyfriend. She hadbeen treated for acute torticollis for three weeks when the new symptoms began.Consultation with an internist led to an MRI examination of the cerebellopontine angles to exclude an acoustic neuroma. The MRI demonstrated an enlarged empty sella. There was no history of pituitary tumor or other sellar disease. Intervention and Outcome: There was complete remission of the symptoms after 1 additional dizzy spell that occurred 3 days after the initial symptom. No intervention was performed, but the stress levels in her life had been reduced. Conclusion: An enlarged empty sella can be present without symptoms and can represent an incidental finding on radiography and MRI. However, an enlarged sella seenon lateral cervical spine radiographs should prompt further evaluation torule out pituitary disease. The normal pituitary has a varied appearance andsignal intensity on MRI depending on the patient's age and pregnancy status
Brubaker D, Friedman L, Nolet PS, Paracondylar Process: A Rare Cause of Craniovertebral Fusion - A Case Report Journal of the Canadian Chiropractic Association. 1999 Dec;43(4): 229-35
A 21-year-old female presented to a chiropractic clinic with chronic neck and headache pain. She had an osseous torticollis and abnormal range of neck motion on rotation to the left. Radiographic examination revealed a unilateral paracondylar process of the occiput fusing to the lateral transverse process of the atlas. A paracondylar process is classified as an occipital vertebra. It is an enlarged bony process of the cranial base which projects caudally towards the transverse process of the atlas. She was treated with spinal manipulation below the level of fusion which resulted in a marked decrease in headache and neck pain. The embryology, frequency, radiographic appearance and clinical implications of a paracondylar process are discussed in this paper.
Ames R, Weightlifting Injuries and Their Chiropractic Management: A Clinical Review. Part 2: Injury and Management Overview Journal of sports Chiropractic and Rehabilitation 1998 Jul;12(2): 71-81
Thie article is a practical clinical progression of the information presented in Part 1. Relevant symptoms, signs, and predisposing factors that help in the development of a diagnosis for acuteand chronic injuries of the soft tissues (cartilage, muscles, fascia, capsules,ligaments, nerves) and the hard tissues (bone, cartilage) are discussed. Appropriatetreatment options and management plans for these injuries, as well as specificconditions, such as exertional headache, chiropractic subluxation complexes,patellofemoral syndrome, compartment syndromes, and lumbopelvic syndromes,are explored. The sports chiropractor is well placed to provide comprehensivehealthcare for those athletes who train with weights.
Dellamonte NA, The Alteration of Spinal Biomechanics After Bilateral Posterior Laminectomy and Fusion With Instrumentation Chiropractic Technique 1997 May; 9(2): 62-6
Objective: To discuss a case of cervical spinal cord compression and the resulting biomechanical changes that occurred in the spine after surgery. Clinical Features: A 34-yr-old woman suffered from cervical pain, radicular pain into both shoulders and arms, headache, and upper motor neuron lesion signs. Intervention and Outcome: A multilevel cervical laminectomy and fusion with instrumentation was performed to relieve pressure from the spinal cord. The patient has resumed activities of daily living but continues to suffer from some of the presurgical symptoms. Conclusion: Biomechanical changes to the spine after surgical bilateral decompressive posterior laminectomy with instrumentation are discussed from a chiropractic point of view. This paper provides a review of the osseous, muscular, and ligamentous changes as they relate and their influence in the sequelae of altered biomechanics of the entire spine.
Schimp D, Atypical Sensory Phenomenon: How to Differentiate Migraine, Seizure, and Transient Ischemic Attack Topics in Clinical Chiropractic. 1995 Sep; 2(3): 29-33
The differential diagnosis of migraine headache, seizure, and ischemic attack can be confounding. This is particularly true when altered somatic sensibility is the only apparent symptom - a complaint that is echoed frequently by patients who present to chiropractic physicians. Unlike migraine headaches, which usually favor a good prognosis, seizures and transient ischemic attacks may be the harbingers of intracranial pathology. Transient ischemic attack is an important risk factor for ischemic stroke, and seizure may be associated with an intracranial mass lesion. Prompt recognition of these disorders and referral to the appropriate specialist can result ina significant reduction in the risk of neurologic sequelae. This article providesa diagnostic algorithm for an atypical sensory phenomenon and cites threecase reports.
Gorman R, Monocular Visual Loss AfterClosed Head Trauma: Immediate Resolution Associated with Spinal Manipulation Journal of Manipulative and Physiolgical Therapeutics. 1995 Jun;18(5): 308-14
Objective: To discuss the case of a patient who demonstrated that injuries may cause both cortical and ocular visual loss that was ameliorated by manipulative care. Clinical features: The patient suffered separate incidents of binocular and monocular loss of vision. A female child, aged 9 yr, presented with bilateral concentric narrowing of the visual fields that returned to normal immediately after spinal treatment. Approximately 1 yr later, she returned with monocular loss of vision after she was struck on the head by a ball. Intervention and Outcome: The child was treated by spinal manipulation under anesthesia; the vision was found to be normal on awakening from the anesthesia. Both visual recoveries were authenticated by an independent ophthalmic specialist. Conclusions: This casehistory adds to the other recorded occasions in which vision is noted toimprove when the spine is manipulated. Discussion is directed to the basic pathogenesis: is her condition a form of psychoneurosis, is it a variant ofmigraine, or could it be a combination of both conditions?
Crowther E, Case Reports: Missed Cervical Spine Fractures: The Importance of Reviewing Radiographs in Chiropractic Practice Journal of Manipulative and Physiolgical Therapeutics. 1995 Jan;18(1): 29-33
Objective: This report reviews the caseof a missed cervical spine in a patient presenting for chiropractic manipulativetherapy. A review of the literature suggests that radiographic examinationsperformed in emergency care settings following cervical spine trauma areoften incomplete for the purposes of screening for contraindications to manipulativetherapy. Sensitivity of the standard radiographic cervical spine series fordetecting fracture suggest an unacceptable high level of false negativesand chiropractors are cautioned to requisition and review all X-rays andensure a complete radiographic series before initiating treatment. ClinicalFeatures: A 65-yr-old woman presented to a chiropractic office for examinationand treatment of cervical spine injuries suffered in a deceleration typemotor vehicle accident. Hospital X-rays were reported normal for fracture. Subsequent radiographs of the cervical spine demonstrated the presence of a posterior arch fracture of C2. Intervention and Outcome: The patient was referred for further imaging and was treated conservatively with bracing ofthe cervical spine. Follow-up 5 months later demonstrated substantial recoverywith some residual stiffness and headache. Conclusion: Radiographs takenat emergency care settings are often incomplete for the purposes of screeningfor contraindications to manipulation. This case demonstrates that chiropractorsshould be extremely cautious in initiating manipulative therapy in thosepatients having sustained previous cervical spine trauma and who have hadprior X-rays that have been reported normal.
Molyneux T, Wittingham W, Thyroid Carcinoma Detected in a Chronic Headache Sufferer: A Case Report Chiropractic Journal of Australia 1994 Mar; 24(1): 23-7
This case report illustrates the value of plain film radiography in day-to-day chiropractic practice. A patient whopresented with chronic headache and cervical spinal joint dysfunction wasradiographed prior to chiropractic manipulation, and the films reviewed byboth authors (a chiropractor and a chiropractic radiologist) revealed trachealindentation and deviation. Appropriate referral for further imaging and subsequenttissue biopsy led to a diagnosis of thyroid carcinoma. The patient's clinicalhistory, plain film and CT images are presented. Eighteen-month follow-upindicated that surgery and radiation therapy have afforded the patient afavourable prognosis. Chiropractic manipulation was not given to this patientin light of the pathology. There has been no relief of the headache.
Fudala R, [letter] Basilar Artery Migraine or Cerebral Vascular Accident? Journal of Manipulative and Physiolgical Therapeutics 1993 Jun;16(5): 354-5
Cashley M, Basilar Artery Migraine or Cerebral Vascular Accident? Journal of Manipulative and PhysiolgicalTherapeutics 1993 Feb; 6(2): 112-4
There are no reports of misdiagnosis of postmanipulative stroke in the literature. This report discusses a case of basilar artery migraine that was misdiagnosed as such. The main diagnostic features of this rare condition are highlighted, as are the relevant differential diagnosis.
Harcourt B, Mitchell T, Occipitalization of the atlas Journal of Manipulative and Physiolgical Therapeutics 1990 Nov; 13(9): 532-38
This paper discusses occipitalization of the atlas and its the chiropractic practitioner. Patients commonly consult a chiropractor with complaint of headache, suboccipital stiffness, restricted motion, dizziness and other symptoms related to the upper cervical region. Differential diagnosis of the exact etiological factor of these symptoms mustbe made via a thorough history, physical examination, and roentgenological examination. If occipitalization of the atlas is detected on the initial roentgenologicalexamination, then follow-up magnetic resonance imaging, computerized tomographyor linear tomographic studies may be warranted to rule out concomitant diverseosseous and/or neural anomalous conditions of the cervical spine which mayeasily mimic symptoms of disorders commonly treated by the chiropractic practitioner.The chiropractic practitioner must obtain appropriate roentgenological andother diagnostic imaging studies to ensure proper evaluation of the structuralintegrity of the cervical spine before appropriate treatment can be rendered.
Takayanagi K, Fujito T, Morooka S, TakabatakeY, Nakamura Y, Headache angina with fatal outcome Jpn Heart J,1990 07, 31: 4, 503-7.
We report 2 fatal cases of angina pectoris in patients who complained primarily of headache during the ischemic attack. The first patient, who was hospitalized because of headache and chest pain, demonstrated repeated ST-segment elevation and fatal ventricular fibrillation on ambulatory ECG monitoring. The second patient had post-infarction angina preceded by headache and by ST-segment elevation in the precordial leads. She eventually died of reinfarction. The mechanism of the headache in relation to the angina pectoris is discussed.
Brennan P, Lohr G, Nodine D, O'Brien J, Natural Killer Cells as an Outcome Measure of Chiropractic Treatment Efficacy Proceedings of the Int'l Conference of Spinal Manipulation 1990 May: 109-12
Natural killer (NK) cells are a unique subpopulation of lymphocytes can be distinguished from thymus derived (T) and bursa-equivalent (B) lymphocytes on the basis of their morphology, cell surface antigens, and ability to kill certain tumor cell lines and virally infected cells in vitro. Depressed natural immunity as measured by decreased numbers and/or activity of circulating NK cells is associated with the development of both leukemias and solid tumors, as well as acute and chronic viral infections (1-3), including chronic fatigue syndrome (3,4). Low numbers or low activity of NK cells has also been associated with various autoimmune diseases (5-8). Recently, depressed absolute numbers of NK cells have been found in patients with clinical psychiatric depression, in patients with chronic headache pain and in otherwise healthy individuals who are experiencing difficulty in handling the everyday stress of normal living (3,9,10). Some workers believe that lowNK numbers and/or low NK activity may be among the most sensitive indicators of biological modulation. As such, low NK cell numbers and/or decreased NK cell function may be useful as prognostic markers for clinical improvement in patients receiving chiropractic therapy. As a first step in examining thishypothesis, we compared NK cell numbers in patients presenting to the mainoutpatient clinic of the National College of Chiropractic over a four monthperiod with NK cell numbers in a group of asymptomatic control subjects.
Wood K, Case Study: Resolution of Spasmodic Dysphonia (Focal Laryngeal Dystonia) Via Chiropractic Manipulative Management Proceedings of the Int'l Conference of Spinal Manipulation 1990 May: 50-3
This case study details the treatment of a 46-year-old male who with classic ASD symptoms of six months duration, including total inability to produce speech, and inability to pass air through the glottis due to vocal cord hyperadduction when attempting speech. Concurrent symptoms included upper cervical pain and stiffness with occasional headache, suboccipitally. He related that the ASD appeared to start after a minor head cold as hoarseness, and although other symptoms improved, the hoarseness persistedand progressively worsened to the current level, and he had been unable toproduce any intelligible speech for four to five months. His level of medicalcare had increased proportionally, with various medications tried, and noresponse. The diagnosis of ASD was eventually confirmed by numerous medicalspecialists at two university-based teaching hospitals, all concurring noorganic etiology, and describing his case as hysterical, recommending psychiatrictherapy. Frustration with the ultimate diagnosis prompted the chiropracticconsultation. The remainder of his personal health history was relativelybenign and considered noncontributory.
Alessandri M, Campagnolo V, Sicuteri F, Fanciullacci M, Fusco B, Unilateral impairment of pupillary response to trigeminal nerve stimulation in cluster headache Pain. 1989 ; 36:185-91
The pupillary constriction induced ipsilaterallyby transcutaneous electrical nerve stimulation (TENS) of the infratrochlearnerve was measured, using an electronic pupillometer, in 26 episodic clusterheadache (CH) and 15 migraine sufferers tested during an attack-free periodand in 16 healthy controls. In controls, TENS gave rise to a miosis whichwas slow in onset and long-lasting in duration, and which was comparableto that mediated by tachykinins in animals. A similar miotic response wasbilaterally observed in migraine patients and in CH patients examined duringthe inactive phase. In CH sufferers during the cluster period, TENS onlyelicited a normal pupillary constriction in the asymptomatic eye, whereasthe resulting response in the symptomatic eye was markedly decreased. Althoughthe exact mechanism underlying the dysfunction remains to be clarified, theseresults seem to indicate that ocular trigeminal pathways are involved inCH.
Jacome D, Basilar Artery Migraine After Uncomplicated Whiplash Injuries Headache. 1986; 26: 515-6
Four female patients with basilar artery migraine (BAM) developing isolated neck injuries, uncomplicated by spinal fractures, luxations or by intracranial lesions, are described. BAM constitutes a subtype of posttraumatic migraine headaches, occurring in the absence of direct head trauma, and moderately and variably ameliorated with common antimigraine medications and physical therapy directed to the injured neck.
Nick J, Bakouche P, [Headache related to sexual intercourse (author's transl)]
Sem Hop, 1980 00, 56: 13-14, 621-8
Co•tal cephalalgia (CC) is rare (1/360 headaches); it occurs more frequently among men. Out of 16 unpublished cases, in 4 cases, CC was the inaugural symptom of vascular attack. In the 12 other cases, CC was isolated or primary. According to the time of onset of headache during co•t one may distinguish three types: 1) early CC usually moderate and short lasting; 2) orgasmic CC, abrupt, severe, lasting 15 to 20 minutes; 3) late CC of long duration (hours, days) follows sometimes orgasmic CC. Isolated CC is usually repetitive but capricious, episodical, not periodical. Prognosis is good. Mechanism is mainly vascular and muscular. The role of high blood pressure, migraine, and psychological factors is discussed.
Hess R, [Epilepsy and headaches (author'stransl)] EEG EMG Z Elektroenzephalogr Elektromyogr Verwandte Geb,1977 09, 8: 3, 125-36.
Lance JW. Headaches related to sexual activity. J Neurol Neurosurg Psychiatry. 1976 Dec;39(12):1226-30
Twenty-one patients experienced headache related to sexual activity. Two
varieties of headache could be distinguished from the clinical histories.The first, developing as sexual excitement mount, had the characteristics of muscle contraction headache. The second, severe, throbbing or 'explosive'in character, occurring at the time of orgasm, was presumably of vascularorigin associated with a hyperdynamic circulatory state. Two of the patientswith the latter type of headache had each experienced episodes of cerebralvascular insufficiency on one occasion which subsequently resolved. A thirdpatient in this category had a past history of drop attacks. No evidenceof any structural lesion was obtained on clinical examination or investigation,including cerebral angiography in seven patients. Eighteen patients havebeen followed up for periods of two to seven years without any serious intracranial disorder becoming apparent. While the possibility of intracranial vascularor other lesions must always be borne in mind, there appears to be a syndromeof headache associated with sexual excitement where no organic change canbe demonstrated, analogous to benign cough headache and benign exertionalheadache.
Chiropractic and Headache Related Literature