Brief overview
- Symptoms: headache during arousal (dull, pressing pain) or during orgasm (sudden onset of pain)
- Causes and risk factors: Not exactly known, possibly disturbed stress processing in the brain, muscle tension, blood pressure increase, more common in men and migraine patients, rarely other neurological causes
- Examination and diagnosis: Neurological examination, exclusion of other neurological causes, if necessary with imaging techniques, such as computer tomography (CT), angiography, magnetic resonance imaging (MRI)
- Treatment: Not always necessary, if necessary exercises to cope with stress, possibly painkillers before sexual intercourse
- Course of disease and prognosis: Good prognosis, in many cases the symptoms disappear by themselves.
What is sexual headache?
Headaches during sex are not always an excuse. There is a type of headache that occurs exclusively during sexual activity: the so-called sexual headache.
Nowadays, experts distinguish two different forms of sexual headache:
Preorgasmic headache, which slowly increases in intensity during sexual intercourse, and orgasmic headache. In orgasmic headache, the headache occurs in attacks and explosions. Orgasmic headache occurs three to four times more often than preorgasmic headache.
One in 100 people is affected by sexual headache once in their lifetime. In men, sex headache is about three to four times more common than in women. Migraine patients are also more likely to get sexual headaches than people without migraines.
Age also plays a role: patients between the ages of 25 to 50 are most commonly affected. For most, the sex headache occurs only over a relatively short period of several weeks to months and then disappears. However, it is possible for the sex headache to recur after a symptom-free period.
Sex headache: when does it occur?
In orgasmic headache, a violent headache occurs very suddenly during orgasm. Sufferers describe the pain as lightning-like and shooting in. The pain attack lasts between one minute and three hours. However, the data on this is still insufficient.
In some patients, the headache persists for a while after sex and remains noticeable as a mild dull ache in the neck region. Similar to migraine, sexual headache presents with symptoms such as nausea, visual disturbances, vomiting, and light hypersensitivity.
In preorgasmic headache, the pain typically spreads from the back of the neck and back of the head to the entire head to the forehead. As arousal increases, so does the pain. Sufferers describe this type of sexual headache as dull and pressing.
For some people, the sex headache worsens when they stand or sit, which is why they usually assume a lying position when this happens.
What causes sexual headache?
Even though sex is not an unpleasant undertaking for most people, it is (positive) stress for the body. During sexual intercourse, for example, heart rate and blood pressure increase, putting a short-term strain on the circulatory system.
Another theory is that during orgasmic headache, blood pressure is elevated due to arousal, which causes the sexual headache. It is possible that the blood vessels do not dilate as needed in the situation, causing the pain in the head.
Since the pre-orgasmic headache is primarily localized in the neck, there is another explanation here: it is assumed that the head and neck muscles have increased muscle tension and that the muscles become really tense during orgasm. The tension presses on nerve cords, which is thought to explain the pain.
There are several risk factors that promote sexual headaches: These include elevated blood pressure, increased stress, male gender, fatigue, and frequent sex within a short period of time. Migraine patients and the 25 to 50 age group are at higher risk for sexual headaches.
How can sexual headaches be detected?
The doctor may also ask the following questions:
- Do you have this headache only during sexual intercourse or in other situations as well?
- Where exactly do you have the pain?
- Do you notice any other discomfort besides the pain, for example, sensory disturbances, speech problems, etcetera?
- Do you suffer from high blood pressure?
- Do you suffer from migraine?
- Do you take any medication?
After the anamnesis interview, the physical examination follows. If necessary, the doctor will check the functioning of the cerebrum and brain stem with simple tests. The doctor’s visit is especially important to rule out dangerous causes of sexual headache, such as a vascular malformation (aneurysm) or a brain tumor.
If one of these rare, serious conditions is suspected, further investigations are necessary.
If the sudden headache occurs for the first time during sex and is very painful, it may be important to use imaging to rule out a brain hemorrhage or cerebral infarction. A headache diary is also helpful to identify a rhythm or triggering factors.
Further examinations
How can sexual headache be treated?
No one has to give up sex to successfully treat sexual headache. Often, the sexual headache goes away on its own over time. Although sufferers may severely limit sexual activity out of fear of sexual headache, there is a theory that sex may be helpful.
During orgasm, the body releases the so-called “happiness hormone” serotonin. This is said to have an analgesic effect on sexual headaches.
Serotonin also causes the vessels in the brain to contract. Well-known migraine medications, known as triptans, also work in this way.
If sexual headaches occur frequently, some sufferers find it helpful to take a mild painkiller such as ibuprofen about an hour before making love. Some also report that the sexual headache worsens when standing or sitting, but improves when lying down – it may help to prefer a lying position.
The brain thus has more time to adjust to the stimulus processing and is not overloaded. If controllable, the orgasm should also be as “gentle” as possible to avoid blood pressure spikes.
When does sexual headache disappear?
The prognosis for sexual headache is usually good. The pain usually occurs in short episodes and disappears after a few weeks or months. However, there is a possibility that sexual headache may recur after years.
However, a chronic course of sexual headache is extremely rare. In that case, sufferers develop a course without headache-free periods.
Sexual activity is an important component of health. However, sexual dysfunction is often still a taboo subject in society. If sexual headache occurs, it depends on the intensity and possible further neurological complaints whether a visit to the doctor is necessary.
If the sexual headache is only mild, it is possible to wait and observe the pain at first. Often the sexual headache is already over after a few attacks.
