The Center for Headache Care and Research
Island Neurological Associates
Headaches that occur during sex can be extremely frightening… and rightly so. This event can be a warning that there may a potentially serious, and possibly life-threatening, underlying problem. As many as 70% of cases could be caused by an underlying problem demanding rapid diagnosis and treatment.
When no underlying cause is found, this is called a primary headache disorder. This generally resolves on its own after a few weeks or months of recurring headaches with sex.
When such a headache occurs for the first time, it is essential to have it rapidly evaluated. A trip to the ER is then mandatory. Potentially serious causes include hemorrhage, aneurysm, spasm of blood vessels, blockages of brain arteries or veins, breakdown (dissection) of blood vessels walls, tumors, infections and medications (especially those used to treat erectile dysfunction).
In cases where it has occurred already on a few occasions, it is more likely a primary headache disorder. It still, however, demands the same intense evaluation as those that occur for the first time. While this should be accomplished quickly, it usually can be done as an outpatient.
Once serious causes have been ruled, treatment can be vey variable. Abstinence for a few weeks is an option decided on by a few patients. Others choose to continue to have sex, but stop short of orgasm if a headache starts to occur. Indomethacin has been shown to be effective for many if taken 30-60 minutes before sex. In patients who have a history of migraine, likewise, taking their usual migraine abortive medication 30-60 minutes before sex has also been reported to be effective.
In summary, headaches occurring around orgasm are potentially a very serious situation. Rapid evaluation and treatment are mandatory if serious pathology is found. When no underlying cause is found, several options for treatment are available.
Guest blogger Dr. Turner is a life-long New Yorker who did his undergraduate work in chemistry at SUNY Binghamton. While at that institution, he was involved in research in the field of ion exchange selectivity. His medical education was at SUNY Downstate Medical Center in Brooklyn, NY. Following graduation from there, he did an internship in internal medicine at Nassau County Medical Center and a subsequent neurology residency at the same institution.
As a neurology resident, he was involved in bench research on the kindling effect as a model of acquired epilepsy and spent substantial elective time in the epilepsy and headache clinics. Following completion of his residency, Dr. Turner became one of the founding partners of Island Neurological Associates in Plainview, NY. From 1990-2000, he was chief of the division of neurology at Plainview Hospital (part of the North Shore/Long Island Jewish hospital system). Over the years he has held faculty positions ay SUNY Stony Brook, Cornell and NYU medical schools.
In 2000 he started the Center for Headache Care and Research at Island Neurological Associates. Research studies have included multiple clinical trials on treatment of episodic and chronic migraine, as well as the disability associated with these conditions. He has also been involved in treatment trials for cluster headache and post-herpetic neuralgia.