4.3 Primary headache associated with sexual activity

A 60-year-old retired postman reports head pain exclusively linked to sexual activity with his wife over the past year. He describes the discomfort mounting steadily as arousal builds, rather than striking suddenly, until it becomes markedly severe by the time intercourse ends. The pain has been intense enough on each occasion that he has needed to lie down in a darkened room, and it has taken about fifteen and a half hours to resolve completely on the most recent episode. He estimates this has now occurred six times in total since it began. He denies any collapse, confusion, or double vision, and there has been no vomiting associated with any episode.