Causes of Headache During Sex

People with "Primary Headache Associated with Sexual Activity" do not have an underlying cause, and their headaches may recur during further bouts of intercourse.

However, it is not possible to predict who will have recurrent episodes. Sometimes they occur, sometimes they don't.

People may not consult their doctor until they have two or more episodes. Some will present immediately after the first occurrence.

However, if someone has this headache for the first time, investigations are mandatory.

People presenting after multiple episodes probably do not need as extensive work-up as those who present just after the first event.

This is a list of causes of headache during sex:

1. Primary Headache Associated with Sexual Activity
2. Subarachnoid Haemorrhage
3. Carotid Artery or Vertebral Artery Dissection
4. Chiari Malformation
5. Reversible Cerebral Vasoconstriction Syndrome

If you critically review the published cases of orgasm headaches, there is only one good case of subarachnoid haemorrhage out of one list of 13 cases.

I suspect that the risk of an underlying cause is probably much much smaller than 1 in 13 (Pascual 1996), but this is the best data we have at present.

A German group studied 51 cases of orgasm and pre-orgasm headache (Frese 2003). They did not identify any cases of subarachnoid haemorrhage or any other serious diseases.

However, these 51 cases were selected from a specialist headache centre. Any obvious serious disease would have been detected by basic screening investigations in local hospitals.

It is said that about 4% of people who actually have a real subarachnoid haemorrhage will have their first headache during the exertion of sexual activity.

To put a more accurate estimate of risk, about 100 out of every million will have a subarachnoid haemorrhage each year.

If only 4% have onset during sex, then about 4 people per million have a serious cause for sexual activity or orgasm headache. (4 per million = 0.00004%).

I must emphasise that a first ever headache during orgasm should be assessed immediately by your doctor.

Your doctor will know about this orgasm headache and will not make you feel embarrassed by talking about what you doing when your headache started.

The most serious of these conditions to miss would be subarachnoid haemorrhage. If this type of brain haemorrhage is misdiagnosed, and the patient has a berry aneurysm, a further bleed is highly likely to be catastrophic.



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