Coital cephalalgia

Coital cephalalgia
Classification and external resources
Specialty	neurology
ICD-10	G44.8
ICD-9-CM	339.82
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Sexual headaches, also known as coital cephalalgia, are a rare type of headache that occur in the skull and neck during sexual activity, including masturbation or orgasm. These headaches are often benign, but should be evaluated by a clinician to rule out intracranial hemorrhage and cerebral infarction, especially if the pain is sudden and severe. They may be caused by general exertion, sexual excitement, or contraction of the neck and facial muscles. Most cases can be successfully treated with medication.

According to the third edition of the International Classification of Headache Disorders (ICHD), which terms this condition primary headache associated with sexual activity, it normally begins as a dull headache that increases with sexual excitement, and becomes intense at orgasm. For some patients, the headache begins suddenly, often at orgasm. In two thirds of cases, it is bilateral, and unilateral in the rest. The pain lasts from one minute to 24 hours with severe intensity, or as long as 72 hours with mild intensity. Its occurrence is unpredictable, and may not follow every sexual act.

Previous editions of the ICHD divided the condition into two subforms, preorgasmic headache and orgasmic headache. These subforms were merged into one entity with varying presentation because clinical studies could not distinguish them. Post-orgasmic headaches associated with posture may be better attributed to a spontaneous cerebrospinal fluid leak. Sudden, severe headaches during sexual activity may also be caused by intracerebral hemorrhage, subarachnoid hemorrhage, or cerebral infarction, which require immediate medical attention.

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