Primary Headache Associated with Sexual Activity: A Review of the Literature.

PURPOSE OF REVIEW: This review summarizes the evolution in diagnosis, evaluation, and treatment of primary headache associated with sexual activity (PHASA). RECENT FINDINGS: Despite increased access to patient information and advances in imaging, the pathophysiology of PHASA remains not fully understood. There are many secondary headaches that may present with headache during sexual activity, and a thorough workup is indicated to rule out potentially life-threatening etiologies. Many recent case series discuss the efficacy of known treatments of PHASA, as well as suggest other potential therapies for this condition including the newer CGRP-targeted therapies. Headaches during sexual activity can be worrisome events which necessitate urgent evaluation, particularly when presenting with sudden-onset and severe "thunderclap" headaches. A thorough workup including imaging should be conducted to rule out etiologies such as subarachnoid hemorrhage, reversible cerebral vasoconstrictive syndrome (RCVS), vasospasm, and dissection. PHASA is commonly comorbid with migraine, tension-type headache, exertional headache, and hypertension. PHASA can present as a dull headache that progresses with sexual excitement, or an explosive headache at or around orgasm. Pain is primarily occipital, diffuse, and bilateral. The headaches are discrete, recurrent events with bouts that typically self-resolve, but may also relapse and remit or continue chronically in some patients. PHASA can be treated preemptively with indomethacin and triptans administered prior to sexual activity, or treated prophylactically with beta-blockers, topiramate, and calcium channel blockers. CGRP-targeted therapies may provide relief in PHASA based on a few case reports, but there are no randomized controlled trials looking at specific efficacy for these therapies.

Investigating the performance of soft robotic adaptive feet with longitudinal and transverse arches.

Biped robots usually adopt feet with a rigid structure that simplifies walking on flat grounds and yet hinders ground adaptation in unstructured environments, thus jeopardizing stability. We recently explored in the SoftFoot the idea of adapting a robotic foot to ground irregularities along the sagittal plane. Building on the previous results, we propose in this paper a novel robotic foot able to adapt both in the sagittal and frontal planes, similarly to the human foot. It features five parallel modules with intrinsic longitudinal adaptability that can be combined in many possible designs through optional rigid or elastic connections. By following a methodological design approach, we narrow down the design space to five candidate foot designs and implement them on a modular system. Prototypes are tested experimentally via controlled application of force, through a robotic arm, onto a sensorized plate endowed with different obstacles. Their performance is compared, using also a rigid foot and the previous SoftFoot as a baseline. Analysis of footprint stability shows that the introduction of the transverse arch, by elastically connecting the five parallel modules, is advantageous for obstacle negotiation, especially when obstacles are located under the forefoot. In addition to biped robots' locomotion, this finding might also benefit lower-limb prostheses design.

Neurologic Care for Transgender and Gender-Diverse People: A Review of Current Evidence and Clinical Implications.

Purpose of Review: To summarize the literature on neurologic care for transgender and gender-diverse (TGD) people and provide implications for clinical practice. Recent Findings: There are limited data on the frequency and management of neurologic conditions among TGD people. TGD people have a higher prevalence of various neurologic conditions compared with cisgender or general population cohorts, including migraine, subjective cognitive decline, sleep disturbances, functional disorders, and cerebrovascular disease. Gender-affirming hormone therapy interacts with commonly prescribed neurologic medications and increases stroke risk among transfeminine people. Sex hormones and sex chromosomes may play a role in neurodegeneration and disability progression in neuroimmunologic diseases. Clitoral reduction surgeries on intersex children can cause neurologic disability and sexual dysfunction in adulthood. Socioeconomic disparities among TGD people contribute to health care barriers. Summary: Neurologists should consider the unique experiences and health care needs of TGD people in their clinical practice and research protocols.