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Reviews
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What are the main claims of the paper and how important are they?
That topiramate at a certain dose my cause an anorgasmic headache.
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Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.
No, but they are interesting. The author appropriately cites previous literature, at least that topiramate my cause anorgasmia.
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Are the claims properly placed in the context of the previous literature?
Yes.
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Do the results support the claims? If not, what other evidence is required?
Yes.
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If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?
NA
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
This is a single case report.
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Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?
It would be interesting to see a case series if possible.
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Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?
It is interesting and I would present this topic at my local institution.
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Other Comments:
The author presents a middle-aged woman with a history of migraines with isolated visual auras who was given prophylactic topiramate for treatment because of increasing frequency of her complaints. Interestingly, the topiramate (at a dose of 50mg po bid) controlled her spontaneous headaches but has a side effect of an anorgasmic headache. This new headache was not associated with any other form of physical exertional activity. Her anorgasmic headache resolved after decreasing the dose of the topiramate. The author provides a nice review of the pharmacology and purported mechanisms of action of topiramate, and also the literature on the rare association of topiramate and anorgasmia. All of the references are appropriate and timely. There are some minor grammatical errors that should be corrected. I would have been interested to know if the patient had any baseline paresthesias while taking the topiramate which may have indicated a mild metabolic acidosis (please see: Topiramate-induced metabolic acidosis: a case study.Fernández-de Orueta L, Esteban-Fernández J, Aichner HF, Casillas-Villamor A, Rodríguez-Álvarez S.Nefrologia. 2012 May 14;32(3):403-4.) and compensatory hyperventilation that may have increased with intercourse (despite the knowledge that her anorgasmic headache did not seem to occur with other forms of physical activity). Also, could there have been an interaction between topiramate and the bupropion and/or the citalopram that the patient was taking? Although uncommon, buproprion has been associated with anorgasmia (Anorgasmia in a patient treated with bupropion SR for smoking cessation. Martínez-Raga J, Sabater A, Cervera G.J Clin Psychopharmacol. 2004 Aug;24(4):460-1.) along with citalopram (Sexual dysfunction and psychotropic medications.Stimmel GL, Gutierrez MA. CNS Spectr. 2006 Aug;11(8 Suppl 9):24-30. Review.) Could the combination of medications somehow have caused the anorgasmia, thus leading to more exertion and hyperventilation which in turn led to the headache?
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Competing interests:
No.
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Invited by the author to review this article? :
No -
Have you previously published on this or a similar topic?:
No
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References:
None -
Experience and credentials in the specific area of science:
General neurology
- How to cite: Rison R A.Anorgasmic Sexual Headache[Review of the article 'Anorgasmic Sexual Headache ' by Jacome D].WebmedCentral 2013;4(1):WMCRW002428
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A forty six year old female with migraine without aura was prescribed to prevent migraine. As a result, topiramate (50mg), an antiepileptic drug, was efficient in controlling spontaneous headaches but with the resultant of recurrent headache only when attempting to reach orgasm (a specific type of pre-orgasmic headache) in sexual intercourse without headaches by other physical activities. The author argued that pre-orgasmic headache is a subtype of tension-type headache while orgasmic headache is true migraine on the basis of the previous reports. A slight reduction of the dose of topiramate (25mg in a.m. and 50mg p.m.), however, was sufficient to surpress the patient's sexual anrgasmic headaches. The author emphasized the recommended dose of the drug to prevent the anorgasmia or sexual headache.
Yes
Yes
It seems more similar cases are necessary (patients) to support the author's claim.
Yes
NA
Accumulation of more similar patients are necessary to clear the cause of anorgasmic headache.
NA
None
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No
No
None
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