The first edition at 1988

A. Diagnostic criteria:

1) Is precipitated by sexual excitement;

2) Is bilateral at onset

3). Is prevented or eased by ceasing sexual activity before orgasm

4) Is not associated with any intracranial disorder such as aneurysm

B. Types

1) Dull type (dull ache in the head and neck that intensifies as sexual excitement increases)

2) Explosive type (A sudden severe explosive headache occurring at orgasm)

3) Postural type (Postural headache resembling that of low CSF pressure developing after coitus)

The second edition at 2004

A. Diagnostic criteria and types

1) Preorgasmic headache

a) Dull ache in the head and neck associated with awareness of neck and/or jaw muscle

contraction and meeting criterion (2)

b) Occurs during sexual activity and increases with sexual excitement; (3) Not attributed to another disorder

2) Orgasmic headache

a) Sudden severe “explosive” headache meeting criterion (2); (2) Occurs at orgasm; (3) Not

attributed to another disorder 1

The third edition at 2013

A. Diagnostic criteria and type

1. Primary headache associated with sexual activity

1) At least two episodes of pain in the head and/or neck fulfilling criteria (2)-(4)

2) Brought on by and occurring only during sexual activity

3) Either or both of the following:

a) increasing in intensity with increasing sexual excitement; b. abrupt explosive intensity just before or with orgasm

4) Lasting from 1 minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity

5) Not better accounted for by another ICHD-3 diagnosis

2. Probable headache associated with sexual activity

1) Either of the following:

a) a single headache episode fulfilling criteria (2)-(4);

b) at least two headache episodes fulfilling criterion (2) and either but not both of criteria (3) and (4)

2) Brought on by and occurring only during sexual activity

3) Either or both of the following:

a) increasing in intensity with increasing sexual excitement; b. abrupt explosive intensity just before or withorgasm

4) Lasting from 1 minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity

5) Not fulfilling ICHD-3 criteria for any other headache disorder