4.3 Primary headache associated with sexual activity

A 54-year-old librarian describes a head pain that has only ever come on during intimacy with her husband. She reports an abrupt, explosive jolt of pain arriving right at the point of climax each time. Curiously, despite the abrupt onset, the pain itself has always stayed on the milder end rather than being crushing or disabling, and she has been able to carry on with her day once it settles. On the last occasion it took roughly three days, almost seventy-two hours by her estimate, before the ache fully cleared. She has now had five such episodes over eighteen months, always in the same context. She reports no nausea, no visual disturbance, and no tingling or weakness in the limbs.