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There appear to be two peak times of onset: in the early 20s and then around age 40 [17]. Occurs during sexual activity and increases with sexual excitement. Not attributed to another disorder 4. There are also reports of HSA occurring exclusively during masturbation [46, 47] and a case of this occurring with nocturnal emission [21]. The acute HSA attacks are usually short lasting but the overall duration of pain can vary widely [17]. Several drugs have been linked in case reports to sexual headaches associated with neurologic symptoms: Amiodarone [23] , birth control pills [24] , pseudoephedrine [7] and cannabis [25]. HSA are benign, but because they can mimic serious conditions, patients need to be properly assessed before reassurance is given and management of HSA started.

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Elliana. Age: 30.
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American Headache Society,

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Macy. Age: 31.
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Because pain can alter sexual experience and behaviour around sexuality for the patient and the couple, this aspect of patient wellbeing must be addressed by the treating physician for good holistic management. Headaches and sexual activity are often treated with humour as a typical way for women to reject male advances. Not attributed to another disorder. The typical story is that the headache occurs during sexual activity, is bilateral and stops or is less severe if sexual activity stops prior to orgasm. As not everyone is comfortable with addressing sexuality with patients, respectful acknowledgement of the situation and appropriate referral can be a useful approach.

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