Two Cases Of Unusual Migraine Auras

Neurological symptoms during sex need urgent tests to look for a serious cause such as a bleed on the brain.  “Thunderclap” headaches, a sudden severe headache like a blow to the head, raise alarm bells and can happen at the time of orgasm. People who experience this headache need to go to the emergency department for urgent assessment. Although it can be due to a serious cause, some people who suffer this turn out to have normal test results. We think their symptoms are a variation of a migraine.

It is important to realize that a migraine is not simply a severe headache with sensitivity to light, nausea, and vomiting. A headache is one form of a migraine, and these can be very disabling, forcing the sufferer to lie in a dark room unable to function for some hours. But a migraine can also be associated with aura. The aura can be a change in sensation, such as in vision (most commonly a zigzag pattern in the field of vision which lasts about 20 minutes and may spread out before receding). The aura can also manifest itself as numbness, weakness, dizziness, or speech disturbance. It can affect virtually any part of the brain or brainstem. To make things more tricky, the aura can occur before, during, after, or separate from a headache. In other words, you can have the migraine aura without any headache at all.

We have discovered an unusual aura, which we think is an unusual form of a migraine. We have found this new syndrome in two patients. These people have a different sort of neurological symptom during sex. Their symptoms are exactly the same as migraine aura (neurological symptoms of a migraine but without a headache). This syndrome is called orgasmic migraine aura. We suspect that other people suffer from this same syndrome.

One patient, a woman aged 23 years, had a history of migraine headaches at other times. She developed symptoms of weakness, dizziness, blurred vision, and slurred speech at the time of orgasm, lasting for 30 minutes. She didn’t have a headache with this. Her symptoms were just like a “brainstem” migraine aura except that they happened with sex.

The other patient was a man, aged 33 years, who had dizziness and sometimes a visual aura (zigzag lines) when he was having sex. He sometimes had the same type of visual aura with a headache at other times. Both of these patients were well between attacks. He also had no headaches with this sex attack.

We don’t know how common this syndrome is. And we don’t know what causes it or other sex-related migraine symptoms.  Both the patients we have looked after had other migraine symptoms at other times.

We know that other forms of exertion can cause thunderclap headaches and other migraine symptoms. The cause is not simply because of high blood pressure or changes in blood vessels. It seems that the sensation pathways in people who have migraines are more sensitive. It may be that the connections between the sensation pathways and other parts of the brain react slightly differently. This is likely due to a complex series of changes in brain “networks.” These networks are the intricate and changeable connections between brain regions. The limbic system and the frontal cortex are involved in the brain responses during orgasm. Further research on this clinical finding should give us insights into migraines and into the regulation of sensation, pleasure, and pain.

In the meantime, it is important to look out for this new syndrome because we can avoid a lot of unnecessary worries if we recognize it. These patients all need tests, especially a full neurological evaluation and a scan to rule out a serious cause for the symptoms, such as a bleed on the brain. Once that is done, a firm diagnosis can help them. The good news is that these patients respond to the usual treatments for migraines, and their symptoms can be controlled.

These findings are described in the article entitled Orgasmic migraine aura: Report of two cases, recently published in the journal Cephalalgia.

About The Author

Heather Angus-Leppan

Heather Angus-Leppan MBBS (Hons), MSc (Epilepsy), MD, FRACP, FRCP is Consultant Neurologist, and Epilepsy Lead at the Royal Free London NHS Foundation Trust and Honorary Consultant Neurologist, National Hospital, University College London. She is an Honorary Senior Lecturer at University College and Imperial College London.

She has a keen and active interest in general Neurology, headache and migraine, epilepsy and chronic pain. Her practice has been enhanced by a wide experience in the northern and southern hemispheres, having worked in Australia, Chile, South Africa and the United Kingdom.

After completing an MD in Sydney, Australia, she came as Visiting Australasian Clinical Fellow to the Radcliffe Infirmary in Oxford in 1993, and subsequently worked as Senior Registrar in Cardiff, and as a Consultant Neurologist and Honorary Senior Lecturer at the Essex Neuroscience Centre.

She is past Honorary Secretary of the Clinical Neurosciences Section of the Royal Society of Medicine, and of the Association of British Neurologists. She is current President of the Clinical Neurosciences Section, Royal Society of Medicine. She has published articles on basic and clinical aspects of epilepsy and migraine.

AC
Alice Caulfield

Alice is a research scientist at the Royal Free London NHS Foundation Trust.

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