What are the other Names for this Condition? (Also known as/Synonyms)

• Benign Sex Headache
• Coital Cephalalgia
• Sexual Headache

What is Primary Headache Associated with Sexual Activity? (Definition/Background Information)

• Primary Headache Associated with Sexual Activity may be described as an uncommon form of primary headache disorder that occurs during sexual activity. It is also known as Benign Sex Headache. The condition is not accompanied by sensory or visual symptoms, dizziness, vomiting, or motor weaknesses
• In order to be termed Primary Headache Associated with Sexual Activity, there should be no physical health condition involving the brain such as a tumor/cyst, blood clot, neurological condition, or mental health disorder
• In Primary Headache Associated with Sexual Activity, the headache generally starts as a dull pain involving both sides of the head that gradually increases in intensity as sexual activity progresses, and finally becoming its most intense during orgasm/climax
• The duration of the pain may range from a few minutes to even 3 days. In about 35% of the cases, the pain is one-sided. The rate of occurrence of the condition (headache attacks) is directly proportional to the frequency of having sex
• Earlier, Primary Headache Associated with Sexual Activity was classified into two different subtypes, namely pre-orgasmic headache and orgasmic headache. However, according to the latest ICHD classification, these subtypes have been removed (i.e., merged into the main entity)
• Sexually-active individuals of any age group, gender, race, or ethnicity may be at risk for Primary Headache Associated with Sexual Activity; a slight preference for male gender is reported. It is reported that nearly 40% of the cases may last for a year to become a chronic condition

The criteria for diagnosis of Primary Headache Associated with Sexual Activity as outlined by the International Headache Society (IHS) is given below:

• At least two episodes of pain in the head and/or neck fulfilling the criteria below
• Brought on by and occurring only during sexual activity
• Either or both of the following:
  • Increasing in intensity with increasing sexual excitement
  • Abrupt explosive intensity just before or with orgasm
• Lasting from 1 minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity
• Not better accounted for by another ICHD-3 diagnosis

(Source: International Headache Society Classification ICHD-3, London, United Kingdom)

Differential diagnosis to exclude the following conditions is very important prior to arriving at a diagnosis of Primary Headache Associated with Sexual Activity:

• Cerebral arterial dissection (both intracranial and extracranial)
• Reversible cerebral vasoconstriction syndrome (RCVS)
• Subarachnoid hemorrhage

Note: When the signs and symptoms does not fulfill all the diagnostic criteria outlined for Primary Headache Associated with Sexual Activity as recognized by the International Classification of Headache Disorders (ICHD), it is defined as Probable Primary Headache Associated with Sexual Activity. Also, if only one episode of sexual activity associated headache is noted in a lifetime, then the condition may be termed “probable”.