Differential Diagnosis for Primary Headache during Sexual Activity

• Single most likely diagnosis
  • Tension-type headache or Coital cephalalgia: This is the most common type of headache associated with sexual activity. It is usually a dull, bilateral ache that can occur at any stage of sexual activity. The exact cause is unknown, but it may be related to increased muscle tension.
• Other Likely diagnoses
  • Orgasmic headache: A rare type of headache that occurs at the moment of orgasm. It is usually a severe, throbbing headache that can be unilateral or bilateral.
  • Migraine: Although less common, migraines can be triggered by sexual activity. They are typically characterized by a severe, unilateral, throbbing headache, often accompanied by nausea, vomiting, and sensitivity to light and sound.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid hemorrhage: A life-threatening condition that can present with a sudden, severe headache, often described as "the worst headache of my life." It is usually accompanied by other symptoms such as nausea, vomiting, and loss of consciousness.
  • Arteriovenous malformation (AVM) or other vascular anomalies: These conditions can cause a sudden, severe headache during sexual activity due to the increased blood pressure and flow.
  • Cervical artery dissection: A tear in the lining of one of the arteries in the neck, which can cause a sudden, severe headache, often accompanied by neck pain and other neurological symptoms.
• Rare diagnoses
  • Chiari malformation: A rare condition where the brain tissue extends into the spinal canal, which can cause headaches, including those triggered by sexual activity.
  • Pituitary apoplexy: A rare condition where the pituitary gland suddenly hemorrhages or becomes infarcted, which can cause a severe headache, often accompanied by other symptoms such as nausea, vomiting, and visual disturbances.