Sex Headaches: Rare, Scary, and Usually Harmless

One respondent to our survey about vaginal dryness mentioned that she had been looking forward to menopause because she expected to get fewer migraines. And then she experienced a sex headache, which she described as “sudden, excruciating, and scary as hell.”

Let’s connect some dots and get some facts about sex headaches.

Dr. Barb DePreeThere haven’t been a lot of studies done on sex headaches, which go by several unpronounceable medical monikers, such as coital cephalalgia, coital headache, or orgasmic migraine. (Just FYI: Sex headaches are NOT considered migraines.) They seem to affect about 1 percent of the adult population. Younger men are more likely to experience them, but so are people with a history of migraines. (There is simply no justice in this world.)

The dot to connect here is that women who get migraines tend to get more of them during the hormonal peaks and valleys of menopause. Our respondent was correct, however, in that once those hormonal swings are resolved, post-menopausal women can usually look forward to some relief. Except for a higher risk of experiencing sex headaches, which aren’t hormonally induced.

Neurologists have identified two sub-categories of sex headache: pre-orgasmic and orgasmic. This may sound like hair-splitting, but the two are very different. A pre-orgasmic headache is a dull ache that builds as sexual tension increases. It’s bilateral (on both sides of the head) and may involve muscular tension in the neck and jaw. Some people have reported that the headache eases if they slow down the sexual pace.

Not fun, to be sure, but also easily resolved by taking an anti-inflammatory, such as ibuprofen, 30 minutes before having sex.

The orgasmic headache—which is anything but—is described as explosive and excruciating. A “thunderclap headache” that occurs during orgasm. It can occur during any kind of orgasm, from masturbation, oral sex, what-have-you. Sufferers describe it as the worst headache of their lives. It usually lasts only minutes (but it sometimes lasts longer), but the experience of having your head explode is exceedingly scary the first time it happens and exceedingly painful at any time.

The important point is that orgasmic headaches are usually treatable and benign, and are thought to be caused by a rise in blood pressure or change in blood vessel diameter, but it’s very important to eliminate the possibility of other serious and life-threatening causes, such as aneurysm or tumor.

So, the first time you get the explosive-type of orgasmic headache, see your doctor pronto for an evaluation. You’re probably fine, but the slight chance of a serious underlying condition makes it imperative to get checked out.

Once the bad stuff has been eliminated, your health care provider may write a prescription (an anti-inflammatory or migraine med, for example) to help you manage any recurrence. About three-quarters of those who experience an orgasmic headache, never get one again. In rare cases, however, they can become chronic. For chronic headaches, a different medication may be necessary.

“The good news is that there are treatments available, and they work," says Dr. Merle Diamond, associate director of the Diamond Headache Clinic in Chicago in this WebMD article. “You don't have to swear off sex.” 

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