Differential Diagnosis for Post Coital Headache

• Single most likely diagnosis
  • Benign sex headache (also known as orgasmic headache or coital cephalalgia): This is the most common cause of post coital headache, often described as a sudden, severe, and short-lived headache that occurs during or after orgasm. The exact cause is unknown, but it's thought to be related to the physical exertion and emotional excitement associated with sexual activity.
• Other Likely diagnoses
  • Migraine: Some people may experience migraine headaches triggered by sexual activity, which can be similar to other migraine episodes but may have distinct characteristics.
  • Tension headache: Sexual activity can sometimes lead to tension headaches, possibly due to muscle tension or other factors.
  • Sinusitis or other sinus issues: If the headache is accompanied by other symptoms like facial pain, nasal congestion, or fever, sinusitis could be a consideration.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid hemorrhage: Although rare, a sudden, severe headache after sexual activity could be a sign of a subarachnoid hemorrhage, which is a life-threatening condition requiring immediate medical attention.
  • Arteriovenous malformation (AVM) or other vascular anomalies: These conditions can cause sudden, severe headaches and are critical to diagnose and treat to prevent further complications.
  • Cervicogenic headache due to cervical artery dissection: This is a rare but serious condition where a tear in the artery wall in the neck can lead to a headache and potentially more severe neurological symptoms.
• Rare diagnoses
  • Phaeochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension and headaches, potentially triggered by sexual activity.
  • Temporal arteritis: An inflammation of the blood vessels in the head, which can cause headaches and is more common in older adults.
  • Hypnic headache: A rare type of headache that occurs during sleep but could potentially be triggered by the relaxation and endorphin release associated with sexual activity.