Some patient may develop a headache during physical exertion and/or sexual activity.

The age of onset is often around 40 years of age.


Features: often bilateral and pulsating with male predominance


Secondary causes:

(1) subarachnoid hemorrhage from an aneurysm or other source

(2) hydrocephalus

(3) arteriovenous malformation

(4) arterial hypertension


In many patients no cause is found and the condition is considered benign. It is important to exclude intracranial pathologies with imaging studies (CT and/or MRI) followed by angioMRI if subarachnoid hemorrhage is suspected.


Classification of sexual headaches:

(1) tension-type headache

(2) vascular headache (appears suddenly during orgasm)

(3) low cerebral pressure possibly due to a dural tear


Therapy with a beta-blocker or indomethacin may be beneficial for benign headaches. An aneurysm may require repair.

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