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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9000
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I have been having terrible headaches few weeks now. They

Customer Question

I have been having terrible headaches for a few weeks now. They start near one temple (as a throbbing, varying in intensity) and after about 10-20 mins the throbbing dulls and it spreads to the top and back of my head as well as neck pain. I just ended an episode that lasted 11days and just got a headache (same kind) again tonight. After the throbbing temple part ends the other headache isn't as severe, but I feel off balanced and almost drunk and this can last for days or even a week or more...slightly nauseous, and very irritable. I don't know what to do at this point. I have suffered headaches for a long time but never anything like this. It may be worth mentioning that A couple weeks prior to the first headache onset, a terrible headache was triggered during an orgasm. I was straining pretty hard and it was an all the sudden headache that I Had never had before.
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

Hello. From your history your diagnosis would be pre-orgasmic headache. This is a fairly common entity, a tension-type headache variant I will attach a webpage on this problem. The concern is that you may have something more serious, the incident with the orgasm was actually a sentinel bleed, caused by a leaking cerebral aneurysm, or AVM (arteriovenous malformation). The statistics actually support the alternative, that this is pre-orgasmic headache, but you should see your physician to discuss this with him. Sentinel hemorrhages as from aneurysms rarely occur, and when they do, they are followed soon thereafter by a subarachnoid hemorrhage that is at least 60% fatal. AVM's or venous angiomas (cavernomas) can bleed as well under lower pressure situations. I would ask if you have a history of any familial arteriovenous abnormalities like aneurysms? Do you smoke cigarettes (cigarettes dramatically increase the enlargement of spontaneous aneurysms)? In terms of treating pre-orgasmic headache, one medication in particular, indomethacin (Indocin) has a long history of success. Some men go to getting BOTOX injections in their scalp muscles which can also reduce the incidence of this problem, but you have to get re-injected every 3 months. Please get back to me after you review the page if you have questions, and I will return to answer them. Please remember to rate my service as this is how I am compensated for my work. Click on the rating stars. Thanks *****

Expert:  Dr. Frank replied 1 year ago.

Customer: replied 1 year ago.
The orgasim headache happened over a month ago, would an aneurysm still be a concern at this point?!
Expert:  Dr. Frank replied 1 year ago.

Tell me some specifics about the incident a month ago. Did you develop a stiff neck or stiff back a few days after? Light bother your eyes. Any nausea? All of this would be signs of a sentinel bleed from an aneurysm or AVM. If none of that then you chance of aneurysm is low. Dr frank

Customer: replied 1 year ago.
The headaches I've been glhaving that starts 2 weeks after orgasim headache so make my neck stiff/ sore. No sensitivity to light. Forgot to mention one thing. I have paeudontiumor but have a LP shunt and this doesn't feel like a high fluid issue. Also, will a regular ct scan find a aneurysm?
Expert:  Dr. Frank replied 1 year ago.

Yes a cta a ct a goo will find it as well as mri. Need to check your valve if not recently done

Customer: replied 1 year ago.
Ct scan with no contrast came back ok. If it were an aneurysm would it move around my head and star and stop?
Customer: replied 1 year ago.
Can you please repy
Customer: replied 1 year ago.
Expert:  Dr. Frank replied 1 year ago.

Hi. I was in a full day conference today, sorry for the delay. I was mentioning the CTA, which means CT angiogram. It is done with contrast to look at the blood vessels from the inside out, for defects like aneurysms or AVM's. Sensitivity is very good, even around the brainstem which can be difficult. No, if the aneurysm was causing your headache, it would have been a one time thing, a "worse headache of my life" experience. It would have been a pressure sensation globally, and then in the following days, the other symptoms I asked you about, which you didn't have. So not to worry. You need treatment for pre-orgasmic headache and a followup to note if it worked. I hope that helps. Dr Frank