HRT-induced primary headache associated with sexual activity: A case report

CasePrimary headache associated with sexual activity (PHASA) is uncommon and can resemble serious secondary causes such as subarachnoid haemorrhage or reversible cerebral vasoconstriction syndrome. We report a 47-year-old woman with a history of migraine with aura who developed thunderclap headaches exclusively at orgasm after her transdermal oestradiol dose was increased from 50 µg to 75 µg twice weekly. Neuroimaging was normal. She also noticed a significant increase in libido during the higher dose period.DiscussionBoth the headaches and libido changes resolved after reducing oestradiol to 50 µg. Clinicians should consider HRT as a potentially reversible trigger in PHASA.