Headache Associated with Sexual Activity

Abstract

Two entities are currently identified: headache occurring before orgasm and headache occurring during orgasm. Primary headache associated with sexual activity is more frequent in men than women (mean age: 40), and is more frequent in migraineurs. Preorgasmic headache is typically a bilateral pain, predominant in the occipital and cervical regions. It is described as a dull ache that increases progressively, typically intensifying as sexual excitement increases, and lasting a couple of hours to several days. This type of headache might be caused by an excessive tightening of the head and neck muscles during sexual activity. Orgasmic headache is the most common variety of sex headache. It usually gives no warning, as in thunderclap headache. Its duration is highly variable (from few minutes to 3 h, usually, but can last up to 48 h). This type of headache is usually isolated, but accompanying symptoms such as nausea, emesis, phonophobia, or photophobia can be found. Practically, this headache must be considered as a thunderclap headache. At first manifestation, a subarachnoid hemorrhage must be ruled out as a priority, and then other medical conditions, as preruptured aneurysm, arterial dissection (carotid, vertebral, or intracranial dissection), diffuse segmental vasoconstriction, bout of hypertension, and CSF hypotension. Once all conditions from the list above have been ruled out, the headache is considered as primary. It is essential to reassure the patient, and propose first nonmedicinal approaches (relaxation, biofeedback, even though scientific evidences are poor for such treatments). If necessary, beta-blockers (propranolol) or calcium-channel inhibitors (diltiazem) can be proposed. Taking indomethacin 30 min before sex could also be helpful.