Orgasmic headaches

Headaches that occur during sexual activity tend to elicit fear and embarrassment. Embarrassment is why most people are not aware that this is a fairly common condition – you would not share your experience at a party. The fear is justified – a rupture of an aneurysm in the brain is a deadly condition with 40% of patients dying before they reach the hospital. Fortunately, even though the pain is excruciating, in the vast majority of cases, the pain of an orgasmic headache is brief and the cause is benign.

Sex-induced headaches are three times more common in men. In 80% of people the pain is sudden, occurs at the time of the orgasm, and lasts 30 minutes to a couple of hours. In the remaining 20%, the pain builds up gradually during sex before the orgasm and often does not reach a crescendo if the sexual activity is aborted.

These headaches tend to be common during sex with the usual partner or less often with masturbation. Anecdotally, aneurysm rupture is more likely to occur during an extramarital affair – due to the divine punishment, or more likely, greater excitement and higher elevation of blood pressure than what would occur with the spouse.

This post was prompted by a recent patient who developed an orgasmic headache during masturbation for the first time at the age of 60. The headache had occurred the day before and had completely resolved by the following day. However, with the first orgasmic headache we usually tend to get an urgent CT scan (the CT scan is better at detecting fresh blood than the MRI) because a small leak from an aneurysm could be the underlying cause of a brief headache. My index of suspicion was low because his neurological examination was normal and he’s had some headaches in the past. But the age of onset was a bit late and aneurysms tend to enlarge with age. We both were reassured by a normal CT scan.

Orgasmic headaches can be recurrent and the pain is so severe that some patients are afraid to have sex. Sometimes the solution is simple – take 400 mg of ibuprofen or naproxen an hour before having sex. If this strategy works, after a few times of taking medicine the headaches may not return. If an over-the-counter medication does not work, a prescription migraine drug, such as sumatriptan (Imitrex) can help. Regular exercise can be helpful in preventing these headaches for people who are out of shape.

In older individuals, a common cause of sex-induced headaches is the cervical spine and neck muscles. These headache are usually not as intense. Another patient of mine, a woman in her late 60s stopped having headaches after I suggested changing her position during sex. Strengthening neck muscles, general conditioning, and taking ibuprofen can also help.