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 that can be good!
The Bad News First
For some people, sexual activity can cause headaches and trigger Migraine attacks called coital cephalgia (headache), exertional headache, or exertionally-triggered 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 News
Once 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,) triptans —Imitrex, Zomig, Maxalt, Amerge, Relpax, Frova, and Axert —, Midrin, propranolol (Inderal), and common analgesics. If the problem persists, daily preventive medications may be in order. Care should be taken not to use the triptans, Indomethacin, DHE, or analgesics more than two or three days a week in order to avoid medication overuse headache, aka rebound.