Sexual headache

Sexual headache
Other names: Coital cephalalgia
SpecialtyNeurology

Sexual headache is a type of headache that occurs during sexual activity, including masturbation or orgasm.[1]

They are typically not serious, but occasionally are the result of intracranial bleeding or cerebral infarction, especially if the pain is sudden and severe.[2] They may be caused by general exertion, sexual excitement, or contraction of the neck and facial muscles.[2]

Most cases can be successfully treated with medication.[2]

Signs and symptoms

According to the third edition of the International Classification of Headache Disorders (ICHD), which terms this condition primary headache associated with sexual activity, it normally begins as a dull headache that increases with sexual excitement, and becomes intense at orgasm,[3] which is called sexual benign headache. For some patients, the headache begins suddenly, often at orgasm,[2] which is called orgasm headache. In two thirds of cases, it is bilateral, and unilateral in the rest.[3] The pain lasts from one minute to 24 hours with severe intensity, or as long as 72 hours with mild intensity.[3] Its occurrence is unpredictable, and may not follow every sexual act.[2]

Previous editions of the ICHD divided the condition into two subforms: preorgasmic headache and orgasmic headache. These subforms were merged into one entity with varying presentation because clinical studies could not distinguish them.[3] Post-orgasmic headaches associated with posture may be better attributed to a spontaneous cerebrospinal fluid leak.[3] Sudden, severe headaches during sexual activity may also be caused by intracerebral hemorrhage, subarachnoid hemorrhage, or cerebral infarction, which require immediate medical attention.[2][4]

Causes

For some patients, the headaches may be related to general exertion. About 40% of patients with sexual headaches in one study also experienced headaches from non-sexual exertion.[2] A pressor response to exercise has been suggested as a mechanism.[5] For other patients, the pain appears to be specifically activated by sexual excitement and contraction of facial and neck muscles.[2]

Sporadic case studies have linked sexual headaches to the use of certain drugs, including amiodarone, pseudoephedrine, birth control pills, and cannabis.[2] It may be secondary to another condition, such as reversible cerebral vasoconstriction syndrome.[2] It is associated with migraines.[2]

Treatment

A physician may recommend engaging in sexual activity less strenuously.[2] Case series have found indomethacin and beta blockers to be successful in treating these headaches.[2][6] Propranolol, Bellergal, and triptans have also been used with success.[2] Anecdotal and indirect evidence suggests a trial of magnesium supplementation may improve symptoms (in subjects with known or suspected low Mg levels).[7]

Epidemiology

These headaches are estimated to appear in roughly 1% of the population.[2] They can occur with sexual activity at any age.[3] It is more common in men than women, with studies putting the gender ratio between 1.2:1 and 3:1.[3]

See also

References

  1. ↑ Garza, Ivan; Robertson, Carrie E.; Smith, Jonathan H.; Whealy, Mark E. (2022). "102. Headache and other craniofacial pain". In Jankovic, Joseph; Mazziotta, John C.; Pomeroy, Scott L. (eds.). Bradley and Daroff's Neurology in Clinical Practice. Vol. II. Neurological disorders and their management (8th ed.). Edinburgh: Elsevier. p. 1776. ISBN 978-0-323-64261-3. Archived from the original on 2023-07-02. Retrieved 2023-06-12.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Cutrer, F. M. & DeLange, J. (2014). "Cough, exercise, and sex headaches". Neurologic Clinics. 32 (2): 433–450. doi:10.1016/j.ncl.2013.11.012. PMID 24703538.
  3. 1 2 3 4 5 6 7 Headache Classification Committee of the International Headache Society (IHS) (2013). "The International Classification of Headache Disorders, 3rd edition (beta version)" (PDF). Cephalalgia. 33 (9): 674–675. doi:10.1177/0333102413485658. PMID 23771276. S2CID 78846027. Archived from the original (PDF) on 2016-03-03. Retrieved 2015-04-15.
  4. ↑ Valença, M. M.; Valença, L. P.; Bordini, C. A.; Da Silva, W. F.; Leite, J. P.; Antunes‐Rodrigues, J. & Speciali, J. G. (2004). "Cerebral vasospasm and headache during sexual intercourse and masturbatory orgasms". Headache: The Journal of Head and Face Pain. 44 (3): 244–248. doi:10.1111/j.1526-4610.2004.04054.x. PMID 15012662. S2CID 37901372.
  5. ↑ Staunton, H P; Moore, J (1978). "Coital cephalgia and ischaemic muscular work of the lower limbs". Journal of Neurology, Neurosurgery & Psychiatry. 41 (10): 930–933. doi:10.1136/jnnp.41.10.930. PMC 493197. PMID 731244.
  6. ↑ Anand, K. S.; Dhikav, V. (2009). "Primary headache associated with sexual activity" (PDF). Singapore Medical Journal. 50 (5): e176–7. PMID 19495503. Archived (PDF) from the original on 2017-11-14. Retrieved 2023-06-10.
  7. ↑ Mauskop, A.; Altura, B. T.; Cracco, R. Q.; Altura, B. M. (1996). "Intravenous Magnesium Sulfate Rapidly Alleviates Headaches of Various Types". Headache: The Journal of Head and Face Pain. 36 (3): 154–160. doi:10.1046/j.1526-4610.1996.3603154.x. PMID 8984087. S2CID 31498913.
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