Background

To differentiate primary headache associated with sexual activity from other devastating secondary causes.

Methods

In this prospective cohort, we recruited consecutive patients with at least 2 attacks of headache associated with sexual activity from the headache clinics or emergency department of a national medical center from 2005 to 2020. Detailed interview, neurological examination, and serial thorough neuroimaging including brain magnetic resonance imaging and magnetic resonance angiography scans were performed on registration and during follow-ups. Patients were categorized into four groups, i.e. primary headache associated with sexual activity, reversible cerebral vasoconstriction syndrome, probable reversible cerebral vasoconstriction syndrome, and other secondary headache associated with sexual activity through a composite clinic-radiological diagnostic algorithm. We compared the clinical profiles among these groups, including sex, age of onset, duration, quality, and clinical course (“chronic” indicates disease course ≥ 1 year). In addition, we also calculated the score of the reversible cerebral vasoconstriction syndrome₂, a scale developed to differentiate reversible cerebral vasoconstriction syndrome from other intracranial vascular disorders.

Results

Overall, 245 patients with headache associated with sexual activity were enrolled. Our clinic-radiologic composite algorithm diagnosed and classified all patients into four groups, including 38 (15.5%) with primary headache associated with sexual activity, 174 (71.0%) with reversible cerebral vasoconstriction syndrome, 26 (10.6%) with probable reversible cerebral vasoconstriction syndrome, and 7 (2.9%) with other secondary causes (aneurysmal subarachnoid hemorrhage (n = 4), right internal carotid artery dissection (n = 1), Moyamoya disease (n = 1), and meningioma with hemorrhage (n = 1)). These four groups shared similar clinical profiles, except 26% of the patients with primary headache associated with sexual activity had a 3 times greater chance of running a chronic course (≥ 1 year) than patients with reversible cerebral vasoconstriction syndrome. Of note, the reversible cerebral vasoconstriction syndrome₂ score could not differentiate reversible cerebral vasoconstriction syndrome from other groups.

Conclusion

Our composite clinic-radiological diagnostic algorithm successfully classified repeated headaches associated with sexual activity, which were predominantly secondary and related to vascular disorders, and predicted the prognosis. Primary headache associated with sexual activity and reversible cerebral vasoconstriction syndrome presented with repeated attacks of headache associated with sexual activity may be of the same disease spectrum.

中文翻译：

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使用复合算法对与性活动相关的头痛进行诊断和分类：一项队列研究

背景

将与性活动相关的原发性头痛与其他破坏性继发性原因区分开来。

方法

在这个前瞻性队列中，我们从 2005 年到 2020 年从国家医疗中心的头痛诊所或急诊科连续招募了至少 2 次与性活动相关的头痛发作的患者。详细访谈、神经系统检查和包括脑磁在内的连续神经影像学检查在登记和随访期间进行了共振成像和磁共振血管造影扫描。通过综合临床-放射学诊断算法将患者分为四组，即与性活动相关的原发性头痛、可逆性脑血管收缩综合征、可能的可逆性脑血管收缩综合征和与性活动相关的其他继发性头痛。我们比较了这些组的临床特征，包括性别、发病年龄、持续时间、质量和临床病程（“慢性”表示病程 ≥ 1 年）。此外，我们还计算了可逆性脑血管收缩综合征的评分_{图 2}是一种用于区分可逆性脑血管收缩综合征和其他颅内血管疾病的量表。

结果

总体而言，共招募了 245 名与性活动相关的头痛患者。我们的临床-放射学综合算法诊断并将所有患者分为四组，包括 38 名（15.5%）与性活动相关的原发性头痛，174 名（71.0%）患有可逆性脑血管收缩综合征，26 名（10.6%）患有可能的可逆性脑血管收缩综合征，7 例（2.9%）伴有其他继发性原因（动脉瘤性蛛网膜下腔出血（n = 4）、右颈内动脉夹层（n = 1）、烟雾病（n = 1）和脑膜瘤出血（n = 1） ）。这四组具有相似的临床特征，除了 26% 的与性活动相关的原发性头痛患者，其慢性病程（≥ 1 年）的几率是可逆性脑血管收缩综合征患者的 3 倍。值得注意的是，可逆性脑血管收缩综合征₂分不能区分可逆性脑血管收缩综合征与其他组。

结论

我们的综合临床-放射诊断算法成功分类了与性活动相关的反复性头痛，这些头痛主要是继发性的并且与血管疾病有关，并预测了预后。性活动相关的原发性头痛和性活动相关性头痛反复发作的可逆性脑血管收缩综合征可能属于同一疾病谱。