Lin PT, Wang YF, Fuh JL, Lirng JF, Ling YH, Chen SP*, Wang SJ*. Diagnosis and Classification of Headache Associated with Sexual Activity Using a Composite Algorithm: a cohort study. Cephalalgia 2021 Dec;41(14):1447-1457 (*Equal contribution)

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.