Sex and Headache
From Encyclopedia of Sex and Sexuality
Sexual headache is relatively rare but often is extremely painful. In one recent survey, it was found in approximately 1 out of 360 headache patients seen at a general neurology clinic. Men are affected four times more frequently than women. The second through sixth decades (teens through fifty-nine) are the usual ages of onset. The headache is unpredictable, occurring at one time and not another. This variability makes it difficult to evaluate the effectiveness of therapy.
There are three general types of sexual headaches: the dull type, the explosive type, and the postural type. Twenty-four per cent of patients with sexual headache have the dull or muscle contraction type, also known as type I. Patients often complain of a tightness or dull pain over all or just the back of the head. This pain may last from hours to days and usually starts early during sexual intercourse, intensifying at orgasm. The headache seems to correlate to the amount of sexual excitement experienced and the contraction of facial and neck muscles. Some patients have found that deliberate relaxation of these muscles during sex sometimes results in moderate relief.
The explosive type headache is the most common subtype. It occurs in 69 percent of patients with sex-related headaches. The pain is described as “explosive” and “throbbing,” usually over the back or frontal areas of the head, on both sides. The headache is often severe enough to interrupt sexual activity. Approximately one-quarter of these patients have a personal or family history of migraine.
Seven per cent have the postural type headache. This headache is felt over the upper neck and base of the head and is accompanied by nausea and vomiting. It may last two to three weeks and then disappear spontaneously.
According to criteria of the International Headache Society (IHS), a professional group devoted to the study and treatment of the symptom, serious brain disorders must be excluded to make a valid diagnosis. A patient who complains of headache during sexual activity needs medical evaluation to exclude the possible presence of brain disease. The sudden onset of severe pain in the explosive type headache is suggestive of bleeding inside the head. It is very important that such patients be evaluated by their physician immediately. Certain strokes may have sexual headaches as the initial symptom; meningitis, an inflammation or infection of the membranes surrounding the brain, may cause sexual headache; and hydrocephalus, or the abnormal enlargement of the normal fluid-filled spaces in the brain, may cause it. Sexual headache may also be the result of a bleeding brain tumor. The sudden onset of an explosive headache may be triggered by a “pheochromocytoma,” a rare, non-malignant tumor that does not occur inside the head and can cause headaches associated with exertion by secreting a chemical with significant effects on blood pressure, the heart, and the blood vessels of the brain. “Recreational” drugs such as amyl nitrate, or birth control pills may contribute to sexual headache too.
[edit] The Causes of Sexual Headache
There are a number of speculative theories as to why such headaches occur. It is not known whether the dull (muscle contraction) and explosive subtypes of sexual headache have a common basis. Some believe there are distinct mechanisms, while other authors suggest that various types of headaches are on a continuum and have similar causes. In the 1970s J. W. Lance treated ten patients with tension headache unrelated to sexual activity. Seven of his patients experienced pain in a similar site and with a similar quality during sex, leading to his theory that muscle contractions account for the dull type sexual headache. Some of Lance’s patients did not meet IHS criteria for headache associated with sexual activity because their headaches did not occur only with sexual activity.
The precise cause of the explosive headache is equally unclear. One might invoke the body’s changes with sexual climax to explain this headache’s origin. An increase in blood pressure with simultaneous acute dilation of the blood vessels and an augmentation in the heart’s output occurs as orgasm approaches. Somehow these changes may lead to a transient increase of pressure in the head.
Treatment with propranolol has been successful in some cases (propranolol is effective in treating migraines). A personal history of migraine was found in 23 percent of patients with the explosive type of sexual headache. Eleven percent had a family history and 28 percent had either a personal or family history of migraines.
[edit] Treatment
Propranolol has been the most successful treatment, in doses of 40 to 200 mg per day. Bellergal S and ergotamine tartrate have also been used. The headache may be avoided or significantly decreased by taking either oral or rectal ergotamine approximately thirty minutes before orgasm. Indomethacin (50 mg) given after dinner, as needed, achieved “clear cut success” in 80 percent of patients with headaches associated with sexual activity. Indomethacin has also been recommended.
[edit] Sex in the Relief of Migraine Headache
James Couch and Candice Bears studied the possible relief of intermittent migraine by sexual intercourse in fifty-seven of their married patients. Twenty-seven (47 percent) of this group achieved some relief of their migraine with sexual intercourse. Ten patients had complete relief and five had moderate relief. Some patients had only transient relief, with freedom from pain for one hour or less. Five percent of these patients reported that sexual intercourse made their headaches worse.
