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SEXUAL BENIGN HEADACHESHeadaches can be associated with sexual activity, especially with orgasm. There are two types of these headaches. In the first type, the excitement accompanying intercourse causes muscle contraction in the head and neck, thus leading to head pain. The second type is a vascular headache. It is a very intense, severe headache usually occurring just before orgasm. It has been called an "orgasmic headache" or "orgasmic cephalalgia." In some instances, the headache is a response to an increase in blood pressure, in which the blood vessels dilate. The headache is not usually related to the amount of physical exertion involved in intercourse. The pain may be located around or behind the eyes. It usually lasts a few minutes, but can last for hours. The headache is usually made worse by movement. The headache most often is a "benign" orgasmic headache; however, the possibility of organic disease should be thoroughly investigated. A headache occurring with orgasm could be a symptom of a brain hemorrhage (bleeding around or inside the brain), stroke or tumor. An accompanying stiffness in the neck may be an indication of bleeding into the spinal fluid. The benign orgasmic headache occurs more frequently in men than women and usually strikes migraine sufferers. Benign orgasmic headache is often effectively treated with migraine medications such as blood-vessel constricting agents, taken before intercourse.
Does the "Big O" cause or stop headaches and migraine? We've all heard the old joke, "Not tonight, dear. I have a headache." Right? Surprisingly enough, for some people, there definitely is a correlation between sexual activity and headache or Migraine. The Bad News FirstFor some people, sexual activity can cause headaches and Migraine attacks called coital cephalgia (headache), exertional headache, or effort Migraine. Such headaches may be benign exertional headaches that can also be brought on by other strenuous activities. They may also be directly linked to orgasm or sexual excitement. Coital headaches may have a duration of up to 24 hours, and are more common among men than women at a ratio of 4:1. Although such episodes are usually benign, it is important that they be correctly diagnosed to rule out organic causes. Tests used to confirm the diagnosis include CT scan, MRI, and MRA. Headaches or Migraine attacks induced by sexual activity may strike prior to, at the time of, or following orgasm. Such attacks have also been documented after masturbation. There are three patterns of occurrence for coital headache:1 Sudden onset: This pattern applies in 70% of coital headaches, and begins just before, during, or immediately after orgasm. The headache is severe, usually throbbing, and may build over minutes or be explosive. Average duration is several hours. Subacute, crescendo headache: This pattern applies in approximately 25% of cases. The onset is much earlier than orgasm, with intensity increasing until the time of orgasm. Frequently in the back of the head, the pain is dull and aching. Rarely, nausea and vomiting may occur. Postdural headache: This is the least common of coital headaches. The pain occurs in the lower back of the head and is greatly increased then the patient stands. This form is more likely to be accompanied by nausea and vomiting. A Brighter Side To the Bad NewsOnce coital headaches are diagnosed benign, medications can be taken one to two hours before anticipated sexual activity to hopefully avoid coital headaches. Some medications that may be used are Indomethacin, DHE (Dihydroergotamine,) Imitrex, Zomig, Maxalt, Amerge, Midrin, Propanolol, and common analgesics. If the problem persists, daily preventive medications may be in order. The Good NewsIn a recent journal article by Randolph W. Evans, M.D. and James R. Couch, M.D., Ph.D., the authors open by saying, "Occasionally, orgasm can trigger a Migraine but, in others, can relieve a Migraine. Dr. Couch's data suggests that some women who decline, 'Not tonight, I have a headache,' may be avoiding an effective treatment."2 study of Migraine relief with sexual intercourse in women was undertaken at Headache Clinic at Southern Illinois University. For those who obtained relief through orgasm, the level of relief varied, but it is interesting to note that of those who obtained any relief, the largest subset is those who obtained complete relief. Of study participants, 47.4% had complete relief, 49.1% had no relief, and for 5.3%, orgasm made their Migraine worse.2 In comparing the efficacy of orgasm to that of Migraine abortive medications, orgasm is significantly less effective than triptans or DHE, but when it is effective, the onset of relief is faster than.Dr. Evans and Dr. Couch conclude their journal article with this statement, "The issue of suppression of headache by orgasm does bring up the possibility of suppression of one multi-faceted, presumably neural origin syndrome (Migraine) by another neural event (perception of sexual orgasm). Perhaps there are other situations in which an indigenous neural process might be used to suppress Migraine. Certainly there are some interesting theoretical possibilities here." Interesting possibilities, indeed! Although this study did not include men, Dr. Evans and Dr. Couch report there is anecdotal information suggesting that relief with sexual orgasm may occur in men, including men suffering cluster headaches. As with so many issues with headaches and Migraine, we find that there wasn't a single answer to our initial question, "Does the "Big O" cause or cure headaches and Migraine?" In searching for answers to the question, both good news and bad news are found, but even for those for whom orgasm sometimes causes headaches, there are avenues of prevention to be explored. Don't give up or be embarrassed to approach your doctor with the problem. The answer might be simpler than you think. __________________________References: 1 Saper, Joel R., Silberstein, Stephen, Gordon, C. David, Hamel, Robert L., Swidan, Sahar. Headache Management: A Practical Guide to Diagnosis and Treatment of Head, Neck, and Facial Pain, Second Edition. Lippincott Williams & Wilkins, 1999, 241-242 2 Evans, Randolph W. & Couch, R. (2001). "Orgasm and Migraine." Headache: The Journal of Head and Face Pain