4.3.1 Probable primary headache associated with sexual activity

A 33-year-old chef reports a fourth occurrence of head pain, each one arising during sex with his boyfriend over the past four months. He describes a steady build-up of pressure as excitement increases, culminating in a sharp peak around climax, and on this occasion he rated the pain as severe, enough to make him briefly stop moving altogether. The pain lasted around eight hours before it began to fade. He denies vomiting, denies any ringing or roaring in his ears, and has had no weakness or visual change with any episode. His only medical history is well-controlled type 1 diabetes, for which he takes insulin as prescribed.