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Headache associated with sexual activity

Walton Centre for Neurology and Neurosurgery, Liverpool, UK; a.larner@thewaltoncentre.nhs.uk

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Professors Frese and Evers in their article on primary headache syndromes associated with sexual activity ( Practical Neurology 2005;5:350–5[Abstract/Free Full Text] ) point out the need for brain CT +/– lumbar puncture to exclude subarachnoid haemorrhage whenever headache associated with sexual activity occurs for the first time. However, they make no comment about the optimal management of cases presenting late—that is, more than 10–14 days after the first headache, when any imaging or CSF signs of haemorrhage would be expected to have disappeared. Is there any evidence base to guide the management of these late presenters? Should they be submitted to angiography? If so, is MR angiography adequate or should a formal catheter study be undertaken? Or is reassurance sufficient? What percentage of such patients harbour an aneurysm? And if they do, is it incidental or symptomatic?