This headache has also been called orgasmic headache, pre-orgasmic headache, sexual headache, coital headache, and benign sex headache. This is a headache that is triggered only by sexual activity. It usually starts as a dull headache on both sides of the head that intensifies as sexual excitement increases, and abruptly becomes severe just before or with orgasm. However, it can also begin as a severe, quick onset headache at any time during sexual activity. The location of the pain can also be one-sided, in the back of the head, or involve the whole head. The severe intensity may last from 1 minute to 24 hours. However, some patients have a milder intensity headache that can last up to 72 hours.
It can be a benign headache syndrome, but can also be associated with Chiari malformation, spinal fluid leak, vascular disorders, brain tumors, other structural abnormalities, aneurysm, tearing of an artery (dissection), other vascular abnormalities, or other “secondary causes”. Therefore, an evaluation with brain scans (brain MRI and brain and carotid artery MRA, or brain and carotid CTA) to exclude these potential treatable causes is necessary. It cannot be diagnosed until examination, further history, a recurrent pattern, and evaluations to exclude other causes of the headache have been performed with a physician. This headache requires urgent evaluation at the nearest emergency department for testing and evaluation, especially the first time that it occurs. One of the main diagnoses that needs to be evaluated for is a blood vessel related headache such as subarachnoid hemorrhage from aneurysm rupture (brain bleed).