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Turner  has provided a good review. Analgesics ibuprofen, diclofenac, paracetamol, acetylsalicylic acid given after onset of headache are of limited or no value in nearly all patients . Other triptans, ergots and benzodiazepines have also been reported to have efficacy [5, 24, 53, 54] for acute and pre-emptive treatment for those patients not tolerating indomethacin.
Long term prophylaxis for longer lasting bouts or continued attacks Options include indomethacin 25mg three times a day, propanolol mg per day, metoprolol mg per day and diltiazem mg per day [15, 19, 20, 22, 24, 45].
Sexual management Trauma due to pain associated with sexual activity has the potential to affect immediate and long term satisfaction with sexual activity unless specifically addressed. HSA can be very distressing for both patient and partner with the development of fears around sexual activity and orgasm.
Patients may develop patterns of impaired sexual arousal. If these fears are not exposed and dealt with, sexual problems may occur. Patients must be given the opportunity to talk about sexual fears in an ongoing way, especially if HSA is chronic.
The social and relationship history will disclose areas of stress which should be evaluated and managed as best possible. In type 1 HSA where neck and jaw tension may be a factor, conscious relaxation of these muscles during intercourse may help . Relaxation exercises especially concentrating on neck and shoulder tension can be done regularly and particularly before anticipating sexual activity.
Individuals often sense early in the lovemaking process whether or not HSA will occur and encouragement not to pursue orgasm on that occasion can be helpful.
Having a disappointed or resentful partner increases the distress of the condition so partner needs have to be discussed. Patients often have difficulty talking about sexual issues with both their partner and their doctor, therefore the doctor needs to be the one to raise the subject.
A brief sexual history will outline the love-making practice and modification to sexual positions, especially where neck tension is exaggerated, may help.
In one report, the advice to engage in intercourse more frequently but less strenuously resulted in a reduction in headaches . Avoiding sexual activity and strenuous activities until totally symptom free has been recommended by some [13, 22, 24, 55].
This may be difficult to follow as the capricious nature of HSA makes knowing when they have stopped difficult. Conclusion HSA are benign, but because they can mimic serious conditions, patients need to be properly assessed before reassurance is given and management of HSA started.
Because pain can alter sexual experience and behaviour around sexuality for the patient and the couple, this aspect of patient wellbeing must be addressed by the treating physician for good holistic management.
As not everyone is comfortable with addressing sexuality with patients, respectful acknowledgement of the situation and appropriate referral can be a useful approach. Johnson, Human sexual response.
Cesk Neurol Neurochir, Klawans, Benign orgasmic cephalgia. Ir J Med Sci, J Neurol Neurosurg Psychiatry, Boes, Cough, exertional and sex headaches.
Neurol Clin N Am, Frese, Comorbidity of migraine and headache associated with sexual activity. Olesen, Symptomatic and non-symptomatic headaches in a general population.
Kraft, Natural course of benign coital headache. An analysis of 72 benign and symptomatic cases. Demography, clinical features and comorbidity. Primary headache attributed to sexual activity. Silbert, Sequential benign sexual headaches and exertional headaches.
Steiner, Coital headaches induced by amiodarone. Jankovic, Benign coital cephalalgia. Villaverde, Sexual headache and stroke in a heavy cannabis smoker.
Int J of Impotence Research, Lopez-Valdez, Benign Valsalva's maneuver-related headaches: An MRI study of 6 cases. Exertional and sexual headaches. Curr Pain Headache Rep, Guideline development and use. Discussing prognosis and end-of-life issues has been identified as an important component of care by patients with progressive life-limiting illnesses, and their families.1, 2 Being adequately informed is essential for such patients and their caregivers to participate in decisions about their treatment and care, to set goals and priorities, and to prepare for death.
Headaches associated with or occurring around sexual activity have been recognized since the time of Hippocrates [1, 2].Wolff  discussed headache during sexual activity in However, these headaches started to be formally reported in the s, first by Kitz in  and then Paulson  and Martin  in The first published study was .
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Reports of sexual assaults at the three military academies surged by more than 50 percent in the school year, and complaints of sexual harassment also spiked, according to documents reviewed by The Associated Press.
Personality Characteristics of Parents Making False Accusations of Sexual abuse in Custody Disputes 1 Hollida Wakefield & Ralph Underwager *. ABSTRACT: Files from contested divorce and custody cases where there were false allegations of sexual .
Volume 10, Issue 4 - December, Editorial: December Special Edition - Ethics in Sport Psychology (Robert Schinke); Ethical and Practical Issues Related to Multiple Role Relationships in Sport Psychology (Jack C. Watson II and Damien Clement) - The primary purpose of this paper is to review the ethical issues related to multiple role relationships, within the sporting realm, as they.