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What is primary sex headache?

Primary sex headache is precipitated by sexual excitement. 
The pain  usually starts as a dull bilateral headache that suddenly becomes intense at orgasm. 
The primary sex headache can be prevented by ceasing sexual activity before orgasm. 
There are three types of sex headache.
  • A dull ache in the head and neck that intensifies as sexual excitement increases
  • A sudden, severe, explosive headache occurring at orgasm
  • A postural headache developing after coitus that resembles the headache of low CSF pressure. The latter arises from vigorous sexual activity and this is a form of low CSF pressure headache.
Headaches occuring at the time of orgasm are not always benign

5–12% of cases of subarachnoid hemorrhage are precipitated by sexual intercourse. 
This type of headache is reported by men more often than women 
Sex headache  may occur at any time during the years of sexual activity.
This may develop on several occasions in succession and then not trouble the patient again, even without an obvious change in sexual activity. 
In patients who stop sexual activity when headache is first noticed, the pain may subside within a period of 5 min to 2 h.
In about fifty percentage of patients, sex headache will subside within 6 months.
About fifty percentage of patients with sex headache have a history of exertional headaches, but there is no excess of cough headache. 
Migraine is probably more common in those patients with sex headache
Benign sex headaches recur irregularly and infrequently.
Treatment of primary sex headache
  • Management can often be limited to reassurance and advice 
  • Propranolol can be used to prevent headache that recurs regularly or frequently, the dosage required varies from 40 to 200 mg/d. 
  • Other drug is calcium channel–blocking agent diltiazem, 60 mg tid. 
  • Ergotamine (1 mg) or indomethacin (25–50 mg) taken about 30–45 min prior to sexual activity can also reduce the headache.