Sexual Headaches: From Ecstasy to Agony

For years, partners have used headache as an excuse to avoid lovemaking. For some people, lovemaking is the cause of the headache.

Forty-year-old Jack was making love to his wife when the pain exploded in his head. "I felt as if someone had plunged an ice pick into the back of my skull," he reported to his doctor later. The pain lingered for about an hour, with no other symptoms, so Jack dismissed the episode as a fluke.

When the pain returned a few days later, once again as Jack was approaching orgasm, he could no longer ignore it. Was he about to die from an aneurysm? Was his sex life in danger of dying too? The pain he had experienced, though short-lived, was enough to make Jack fearful of making love again.

Though reluctant to discuss his sex life with his doctor, Jack made an appointment and described his symptoms. To his relief, the doctor was able to rule out a hemorrhage and other life-threatening conditions. He diagnosed Jack's pain as benign sexual headache, a lesser-known type of headache triggered by orgasm.

These headaches are rare and are most common in men. They can appear in the 20's and then again in the mid-30's. If you have these types of headaches, it is important to see your doctor to make sure you do not have a more serious condition. If you are prone to headaches, especially migraines, here is some information that may be helpful.

Physical and Psychological Effects

What exactly is a benign sexual headache (also known as benign coital headache, orgasmic headache, or orgasmic cephalgia)? It is a sudden, intense pain near or at the moment of orgasm. The pain remains intense for 5-15 minutes, though some people report pain lasting as long as several hours or up to 2 days. Pain can occur with intercourse or masturbation, and may happen infrequently, or every time a person approaches orgasm.

There are different types of headaches depending on how and when they happen:

• Dull—This type of headache starts as a dull ache that intensifies with increased sexual excitement and gradually subsides once sexual activity ceases. People with this type of headache may not even make the connection between their pain and sex, and are less likely to seek medical help.
• Explosive—The explosive type of benign sexual headache is characterized by sudden, intense pain just before or at the moment of orgasm. This is the type most often seen by doctors.
• Postural—This type is rare. Like explosive sexual headaches, postural headaches begin with intense pain at orgasm. The pain then subsides, but reoccurs when the person stands up.

Avoiding sexual activity can create relationship problems. Remember to be up front with your partner so they can understand what is going on as well.

The Cause

There is not an exact cause of benign sexual headaches, though they are classified with other headaches brought on by exertion, such as the exercise, which may be experienced by joggers and weightlifters. The dull type of headache is usually due to muscle contraction in the head and neck from excitement, similar to tension headache. The explosive types of headaches are thought to be brought on by changes in blood vessel regulation leading to blood vessel dilation, similar to migraine headache.

Research supports that people who have a history of migraines and tension headaches have a risk of having benign sexual headaches more often as those who do not.

Prevention Options

Analgesics, such as ibuprofen or acetaminophen, have little effect once the headache begins. Fortunately, treatment to prevent a recurrence of benign sexual headaches is both simple and effective.

Again, your doctor will first want to rule out other, more serious causes of head pain, such as a broken blood vessel in the brain (stroke) or aneurysm. A physical exam would reveal symptoms of hemorrhage, such as stiff neck, change in pupil size, vomiting, or pain that persists for more than 24 hours. If you have recurrent problems or other symptoms, your doctor may set up an MRI or CT scan for you.

Options for prevention include:

• Take a less active role—Once your doctor has diagnosed benign sexual headache, you may have to take a less active role during sexual activity. If symptoms develop, you should stop all activity. Often the headaches will just stop happening, although they might return in the future.
• Prescription medication may work if other treatments do not. Taking propranolol regularly or indomethacin before sex can also help prevent headaches.

Though painful and sometimes frightening, benign sexual headache does not mean an end to a satisfying sex life. Getting proper treatment usually lead to a permanent cure.

Revision Information

• Reviewer: Michael Woods, MD
• Review Date: 08/2016
• Update Date: 08/03/2016