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Dr. Bob
Dr. Bob, Medical Doctor
Category: Medical
Satisfied Customers: 5118
Experience:  20 Years in Internal Medicine, Neurology and Sports Medicine
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Medium to severe headache when having intercourse or. Not

Customer Question

medium to severe headache when having intercourse or orgasm. Not usually prone to headaches but lately pretty bad
Submitted: 12 days ago.
Category: Medical
Expert:  Dr. Bob replied 12 days ago.

Are you taking any ED medications?

Expert:  Dr. Bob replied 12 days ago.

You may be experiencing primary sexual headaches, or "coital cephalgia". Several theories have been put forth to explain the underlying mechanism of these headaches. The leading explanation involves exertion leading to a sudden increase in intracranial pressure (similar to headaches caused by weight lifting) or an inappropriate reaction in the cerebral vasculature (eg vasodilation). Neural hypersensitivity, similar to migraine, may also play a role. Risk factors include obesity, kneeling position during intercourse, a high degree of sexual excitement, stress, history of migraine and exertion headache and a family history of headache or occlusive arterial disease. Pharmacological triggers may include marijuana, amyl nitrite, amphetamines, sildenafil, cialis and some anxiolytics.

Expert:  Dr. Bob replied 12 days ago.

If these headaches are new and severe, you should see your GP and ask about an MRI of the brain to rule out any possible underlying vascular abnormalities (subarachnoid bleeding, basilar artery dissection, etc).

Expert:  Dr. Bob replied 12 days ago.

The primary treatment is usually reassurance as the headaches are not usually recurrent. Drug management can be offered in some cases. Indomethacin and propranolol are the most established and evidenced treatments but all of the following are supported by randomised trials:

Expert:  Dr. Bob replied 12 days ago.
  • Propranolol - 40-240 mg a day. This can be used on a preventative basis.
  • Indomethacin - 25-75 mg a day can be used on an intermittent or regular basis.
  • Topiramate (50 g daily) has been successfully used as prophylaxis in patients in whom the above two drugs were not appropriate.
  • Calcium-channel blockers (eg, diltiazem 60 mg tds, nimodipine) have been helpful in some patients, particularly where cerebral vasoconstriction is the probable cause.
  • One study reported a role for triptans (migraine medications), both in the acute phase and in prophylaxis of headaches associated with sexual activity.