Sexual headache

Dr. med. Julia Schwarz is a freelance writer in the medical department.

More about the experts All content is checked by medical journalists.

Sex headache is a headache that occurs during sexual activity before or during orgasm. The pain often begins in the neck and slowly or suddenly pulls forward to the forehead and temples. Shortly afterwards, the symptoms usually subside. The causes of sexual headache are still unknown. However, there are various risk factors that favor occurrence. For example, men are more often affected than women. The sexual headache usually disappears after a few weeks or months without specific treatment. Here you can read everything you need to know about the disease.

Sexual headache: description

Having a headache during sex isn't always an excuse. There is a separate type of headache that typically occurs exclusively during sexual activity: the so-called sexual headache. Hippocrates in ancient Greece described that an orgasm causes a headache. At that time, the physician classified headaches that arose from running, running and hunting and sexual headaches that were caused by other "unreasonable activities" such as excessive sexual intercourse.

Nowadays experts differentiate between two different forms of sexual headache: the pre-orgasmic headache, which slowly increases in intensity during sexual intercourse, and the orgasmic headache. In the case of orgasmic headache, the headache occurs in a seizure and explosive manner. The orgasmic headache occurs three to four times more often than the pre-orgasmic headache.

Sex headache affects 1 in 100 people at one point in their life. Men are three to four times more likely than women to suffer from it. Migraineurs are also more likely to get sexual headaches than people without migraines. Age also plays a role: Patients between 25 and 50 years of age are most often affected. For most, the sex headache only occurs over a relatively short period of several weeks to months and then disappears. Nevertheless, the sexual headache can return years later and cause new symptoms.

Sexual headache: symptoms

Any kind of sexual activity, especially an orgasm, can trigger the sexual headache - but the symptoms of the two types of sexual headache differ slightly. With orgasm headache, severe headache occurs very suddenly during orgasm. Those affected describe the pain as lightning-fast and shooting. The length of the pain attack can vary from a minute to three hours. However, the data on this are still insufficient. The headache lingers on in some patients and remains noticeable as a slight dull pain in the neck region. Similar to migraines, nausea, visual disturbances, vomiting and hypersensitivity to light can also occur as part of the disease.

With pre-orgasm headache, the pain, which is described as dull and pressing, typically spreads increasingly from the neck and back of the head to the entire head to the forehead. As the excitement increases, so does the dull pain. Those affected often report that this sexual headache worsens when standing or sitting, which is why they usually assume a lying position.

Sexual headache: causes and risk factors

The causes of the sexual headache are largely unexplained. One theory of the emergence assumes that those affected have an altered internal brain stress regulation mechanism. Similar to migraine sufferers, the body then reacts with headaches in stressful situations. While sex is not an uncomfortable endeavor for most people, it is stress for the body, albeit in a positive way. During sexual intercourse, for example, the heart rate and blood pressure rise, which puts a strain on the circulation.

Another theory is that in an orgasmic headache, the blood pressure is increased due to arousal, which creates the sexual headache. In the situation, the vessels could not widen as needed, causing pain in the head.

Since the pre-orgasm headache is primarily localized in the neck, there is a different explanation: It is assumed that the head and neck muscles show increased muscle tension and that the muscles are literally tense during orgasm. The tension presses on nerve cords, which is supposed to explain the pain.

There are various risk factors that favor sexual headache: These include increased blood pressure, increased stress, gender fatigue and more frequent sex within a short time. Migraineurs and those aged 25 to 50 have a higher risk of developing sexual headaches.

Sexual headache: examinations and diagnosis

Anyone who increasingly notices headache symptoms during sex should consult a doctor. A neurologist is usually the right person to talk to when headaches need to be clarified. By describing the current complaints and previous illnesses (anamnesis), the doctor receives important information about your complaints. Typical questions from the doctor could be:

Do you only have this headache during intercourse or in other situations too?
Where exactly do you have the pain?
Besides the pain, do you notice any other complaints, for example paresthesia, speech disorders, etc.?
Do you suffer from high blood pressure?
Do you suffer from migraines?
Do you take any medicine?

The anamnesis is followed by a physical examination. If necessary, the doctor checks the functionality of the cerebrum and brain stem with simple tests. A visit to the doctor is especially important to rule out dangerous causes of the sexual headache such as a vascular malformation (aneurysm) or a brain tumor. However, this is only possible with further examinations.

If the sudden headache occurs for the first time and is very painful, a cerebral haemorrhage or a cerebral infarction should be ruled out by means of imaging tests. A headache diary can also help identify a rhythm or triggering factors.

Further investigations:

The diagnosis of "sexual headache" is a diagnosis of exclusion. This means that the diagnosis “sexual headache” can only be made if serious illnesses have been excluded. In order to do this, imaging procedures such as computed tomography (CT), angiography or magnetic resonance imaging (MRI) are usually necessary.

Sexual headache: treatment

Nobody has to go without sex in order to successfully treat the sexual headache. Often times, the sexual headache goes away on its own. Even if those affected may severely restrict sexual activity for fear of a recurring sexual headache, there is the thesis that sex can even be helpful. The serotonin released during orgasm therefore has an analgesic effect on the sexual headache. Serotonin is popularly known as the "happiness hormone" because it has a mood-enhancing effect. It also leads to a contraction (constriction) of the vessels in the brain. Well-known migraine drugs called triptans also work in this way.

If you have more frequent sexual headaches, it can be helpful to take a mild pain reliever such as ibuprofen or diclofenac about an hour before making love. Some people also report that their sexual headache worsens when standing or sitting, but improves when lying down - so you may want to prefer this position.

If the triggering factors are known, the person affected can reduce the stress at home with targeted relaxation exercises. Increasing sexual arousal too quickly is also a possible triggering factor in the sexual headache. Extended foreplay with cuddles helps to slowly increase blood pressure. The brain thus has more time to adjust to the processing of stimuli and is not overloaded. If you can control it, the orgasm should also proceed as "gently" as possible in order to avoid blood pressure peaks.

Sexual headache: disease course and prognosis

Sex headache has a good prognosis. The pain usually occurs in short episodes and disappears after a few weeks or months. However, the sexual headache can reappear years later. However, a chronic form is extremely rare. Then those affected develop a course without headache-free phases.

Sexual activity is an important part of good health. However, sexual dysfunction is often still a taboo subject in society. If a sexual headache occurs, it depends on the intensity and any other neurological complaints whether a doctor needs to be consulted immediately. If the sexual headache is only mildly pronounced, you can wait and see the pain a little more. Often the sexual headache is over after a few attacks.

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