Headaches Associated With Sex Are No Joke

July 8, 2014
Mark L. Fuerst

Despite comedians’ assertions to the contrary, sex-associated headaches are not funny. But medications can help relieve or even prevent them.

Comedians have long joked about spouses avoiding sex by claiming to have a headache, but headaches associated with sex are no laughing matter, according to a headache specialist.

“Many people who experience headaches during sexual activity are too embarrassed to tell their physicians, and doctors often don’t ask,” said José Biller, MD, Chair of the Department of Neurology with the Loyola University Chicago Stritch School of Medicine and certified in Headache Medicine by the United Council for Neurologic Subspecialties. Sexual activity is comparable to mild- to moderate-intensity exercise, he noted.

“Headaches associated with sexual activity can be extremely painful and scary,” Dr Biller said. “They also can be very frustrating, both to the individual suffering the headache and to the partner.”

About 1% of adults report that they have experienced headaches associated with sexual activity and that such headaches can be severe. But the actual incidence is certainly higher, Dr Biller noted.

Headaches usually are caused by disorders such as migraines or tension, and the vast majority of headaches associated with sexual activity are benign. But headaches also can be secondary to other life-threatening conditions. In a small percentage of cases, these headaches can result from a serious underlying condition, such as a hemorrhage, brain aneurysm, stroke, cervical artery dissection, or subdural hematoma. “We recommend that patients undergo a thorough neurological evaluation to rule out secondary causes, which can be life-threatening,” Dr Biller said. “This is especially important when the headache is a first occurrence."

In 2004, the International Headache Society classified headaches associated with sexual activity as a distinct form of primary headache. The following are the 3 main types of sex-related headaches:

• A dull ache in the head and neck that begins before orgasm and gets worse as sexual arousal increases. It is similar to a tension headache.

• An intensely painful headache that begins during orgasm and can last for hours. This so-called thunderclap headache grabs attention because it comes on like a clap of thunder. Dr Biller said patients describe this headache as “all of a sudden, there was a terrific pain in the back of my head. It was like someone hit me with a hammer.”

• A headache that occurs after sex and can range from mild to extremely painful. This headache gets worse when the patient stands and lessens when the patient lies back down. The cause is an internal leak of spinal fluid, which extends down from the skull into the spine. When there is a leak in the fluid, the brain sags downward when the patient stands, causing pain, he explained.

Dr Biller said men are 3 to 4 times more likely to get headaches associated with sexual activity than women. Depending on the type of headache, medications can help relieve the pain or even prevent the headache, he said.

To reduce the risk of headaches associated with sexual activity, doctors should counsel patients to exercise regularly, avoid excessive alcohol intake, maintain a healthy weight and, if necessary, seek counseling, Dr Biller said.