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1. MIGRAINE 2. TENSION-TYPE HEADACHE (TTH) 3. CLUSTER HEADACHE AND OTHER TRIGEMINAL AUTONOMIC CEPHALALGIAS 4. OTHER PRIMARY HEADACHES 4.2. Primary cough headache 4.3. Primary exertional headache 4.4. Primary headache associated with sexual activity 4.4.1. Preorgasmic headache 4.4.2. Orgasmic headache 4.5. Hypnic headache 4.6. Primary thunderclap headache 4.7. Hemicrania continua 4.8. New daily-persistent headache (NDPH) Bibliography

IHS	Diagnosis	ICD-10
4.4.2	Orgasmic headache	G44.805
Coded elsewhere	Postural headache resembling that of low CSF pressure has been reported to develop after coitus. Such headache should be coded as 7.2.3 Headache attributed to spontaneous (or idiopathic) low CSF pressure because it is due to CSF leakage.

Diagnostic criteria:

Sudden severe ("explosive") headache meeting criterion B
Occurs at orgasm
Not attributed to another disorder¹

Note:

On first onset of orgasmic headache it is mandatory to exclude conditions such as subarachnoid haemorrhage and arterial dissection.

Comment:

An association between 4.4 Primary headache associated with sexual activity, 4.3 Primary exertional headache and migraine is reported in approximately 50% of cases.

Two subtypes (dull type and explosive type headache) were included in the first edition of The International Classification of Headache Disorders. No specific investigation has been undertaken since then to clarify whether they are separate entities. In most published reports of headache with sexual activity, only explosive ("vascular type") headache has been reported. The dull type may be a subtype of tension-type headache, but no evidence supports this hypothesis.

No firm data are available on the duration of primary headache associated with sexual activity, but it is usually considered to last from 1 minute to 3 hours.

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IHS vs. ICD-10

To facilitate headache diagnosis in daily practice, the classification provides the corresponding WHO ICD-10NA codes for each IHS code.

IHS Subcommittee

The Classification Subcommittee prepares and revises the International Classification of Headache Disorders.

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Cephalalgia

Cephalalgia is the official journal of the IHS. It contains original papers on all aspects of headache. The journal provides an international forum for original research papers, review articles and short communications.www.cephalalgia.org

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