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Now dear, I have a headache! Immediate improvement of cluster headaches after sexual activity
  1. M Gotkine,
  2. I Steiner,
  3. I Biran
  1. Department of Neurology, Hadassah University Hospital and the Hebrew University-Hadassah Medical School, Jerusalem, Israel
  1. Correspondence to:
 M Gotkine
 Department of Neurology, Hadassah University Hospital, Box 12000, Jerusalem 91120, Israel; marcgotkine{at}gmail.com

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The precise pathogenesis of cluster headaches is unknown, but a hypothalamic generator has been postulated as the cause of the disorder.1 In two patients with typical cluster headaches, sexual activity alleviated the episodes. This association may shed some light on the pathogenesis and treatment of this incapacitating disorder.

Patient 1: A 61-year-old, previously healthy man presented with excruciating, left-sided orbital headaches appearing in bouts that lasted for 10 weeks. The pain occurred nightly at around 22:00 h, and was associated with ipsilateral ptosis, lacrimation and rhinorrhoea. Neurological examination and brain imaging were normal and he was diagnosed with cluster headaches, according to International Headache Society (IHS) criteria.2 The headaches always lasted for 90–150 min, except for instances when the patient had sexual intercourse, which at the point of orgasm resulted in instant dramatic improvement in the pain, with complete relief always being achieved within several minutes and no recurrence until the next evening. Orgasm occurred on six occasions between 5–30 min after the onset of the episode …

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