Headache associated with sexual activity
Headache
associated with sexual activity is the term preferred by the International Headache
Society for the class of benign sexual headaches. Some authors use the term
"benign sexual headache" or "benign coital headache."
However, using "benign coital headache" as a label for all benign
headaches associated with sexual activity is too restrictive, for such
headaches also occur with masturbation.
The 3 types of benign headaches associated with sexual activities are:
1).
Dull type: a dull ache in the head and neck that intensifies as sexual
excitement increases.
2).
Explosive type: a sudden severe ("explosive") headache occurring at or
seconds before orgasm.
3).
Postural type: Postural headache resembling that of low CSF pressure headache.
This headache type is known as coital
headache or orgasmic headache. Although anxiety associated with illicit
sexual encounters may, at times, be accountable for headache, sudden
excruciating, throbbing, occipital headache, usually occurring just before or
after orgasm, is not likely to have a psychogenic mechanism and represents
coital migraine. (Raskin, 1988) Wolff (1963) was the first to recognize that a
benign headache syndrome could arise in association with sexual activity. In
some patients, the headache occurs regularly with sexual activity, but in most
it develops unpredictably and infrequently, correlates poorly with the level of
sexual excitement, and the physical exertion is expended at these times. Men
seem to be effected much more commonly than women (4:1 ratio); the age at onset
ranges from the second through the sixth decades of life with a mean age of 40
years. This topic has been reviewed by Braun and Klawans (1986), Johns (1986).
Three different patterns of headache may occur in
association with sexual activity, including masturbation. The most common
begins at or shortly before orgasm, is of high intensity, usually frontal or
occipital in location, and is explosive or throbbing in quality. It can persist
for minutes to a few hours and a milder dull headache may linger for as long as
48 hours (Johns 1986). Selwyn (1985) reported that some patients have observed
that headache could be avoided if the neck was kept lower than the body during
coitus.
Lance (1976) performed lateral carotid angiography on 7 of
his 21 patients and vertebral angiography on 2 without documenting an
abnormality. Rarely an unruptured aneurysm may result in a headache syndrome
during coitus that is indistinguishable from benign coital headache (Day and
Raskin, 1986). The presence of vomiting or severe headache lasting more than 24
hours definitely calls for neuroimaging studies probably including four-vessel
cerebral angiography.
A second headache syndrome which is believed to be dependent
on facial and neck muscle contraction begins earlier during the course of
making love and is occipital or diffuse in character becoming most severe at
orgasm. The least common headache syndrome associated with sexual activity is a
postural suboccipital headache markedly accentuated when the patient is upright
and associated with nausea and vomiting. Paulson and Klawans (1974) documented low
CSF pressure in two cases. Headache persists for 2 to 3 weeks and spontaneously
stops. Raskin (1988) believes that the coital headache syndrome resembles that
of a pheochromocytoma, in that a similar vascular pressor mechanism may be
responsible. Because of the variation in physical energy expended and
variations in blood pressures at the time of occurrence of this benign headache
none of the phenomenon are well-explained by any one biological variable.
Propranolol and indomethacin are recommended as considerations
for therapy. Verapamil 240 mg sustained release may completely blocked the
syndrome.
These headaches are not severe enough to induce most folks to consult a physician. They begin early in lovemaking as a dull occipital or generalized headache, and then intensify near and during orgasm. Afterwards, the pain fades away within an hour or so. Ceasing sexual activity alleviates the pain more quickly. This type of sexual headache is probably a milder presentation of the explosive type, since some individuals experience the dull type on some occasions and the explosive type on others.
This
is the type most commonly seen by physicians. It occurs explosively near or at
orgasm, is excruciating, is most often felt in the back of the head on both
sides (but some are one sided), and remains intense for about 15 minutes,
although some don't disappear for a day or two and may even remain intense for
this long.
This type resembles the explosive type in its onset and intensity, but after the severe headache fades, it is re-activated when the sufferer stands up. Because this relation to posture resembles the headaches after spinal taps, authors have suggested that it's caused by a tear in the meninges.
Treatment
Sexual headaches are generally self-limiting, and treatment is not needed.
Over-the-counter analgesics may be helpful. In more serious or persistent cases
of documented sexual-related headache, indomethacin (Indocin), a nonsteroidal
anti-inflammatory drug, or propranolol (Inderal), a beta-blocker, may be
prescribed to be taken before anticipated sexual activity.
Prevention
There is no prevention.