Post coital headache

Let us discuss post-coital headache also at times referred to as orgasmic headache. What is post coital headache?  The history is quite typical. This is a throbbing and at times intense headache which comes on at or near the height of orgasm. During coitus as sexual excitement increases, the muscles around the shoulder and neck become tense. There is increased blood flow to the brain and either at the height of the orgasm or soon after the patient complains of throbbing and at times intense holocranial (whole head) headache.

Post coital headache is relatively benign and does not warrant any urgent treatment. As the sexual excitement weans off, the headache too subsides and usually by the time the patient reaches the ER to seek care, the headache is subsiding or already gone. There is though one entity which can mimic a post coital headache in its clinical presentation and which warrants urgent evaluation. This is the headache which occurs when an aneurysm ruptures in the brain. Classically an aneurysmal headache is described by the patient as the ” worst headache of my life“. It is intense, holocranial, throbbing and accompanied by a stiff neck (as you can see the clinical presentation may resemble that of a post coital headache). An aneurysmal bleed though may be accompanied by other neurological signs and symptoms depending upon where the bleed has occurred in the brain and patients are usually obtunded by the time they reach the hospital. An aneurysmal bleed is a medical emergency and needs to be evaluated and treated urgently. Usually a special kind of scan is carried out to localize the site of the aneurysm and then either the aneurysm is coiled or clipped to secure it. I shall discuss the management of aneurysms in a separate post.

Nitin Sethi, MD

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19 thoughts on “Post coital headache

  1. i use to feel as if my head is filled with blood and its going to come out of my nose. this intensifies whenever i bend or lie down and also whenever i ejaculate

  2. Dear Victor,
    thank you for writing in. Unfortunately you give me precious little history to comment on your case in particular. Follow up with your doctor, let him do a basic check up, check your blood pressure etc. He shall be the best person to recommend if any further testing is warranted.

    Personal Regards,
    Nitin Sethi, MD

  3. my husband’s headaches fit the typical picture of post coital headache. he does not normally have headache at all, and there are gaps between sex headache of months and sometimes years. we wonder if there is anything that can be done to avoid this? do anti-inflammatories work? thank you

  4. Dr. Sethi,

    About 8 days ago I experienced what appears to be a Post Coital Headache just prior to ejaculation. The pain was very intense and spread through my entire head quickly. Since then I have experienced a dull headache constantly with 2 other episodes of intense pain. I have been given a CT scan which found nothing and an MRI that I am currently waiting for the results. My question is, if the MRI comes back normal what should my next steps be to solve this problem ie…massage, chiropractic care or acupuncture? All of which I am currently trying, except acupuncture which I have an appointment for in two days. Is there anything else that I have not tried or thought of?

    • Dear Tom,
      Thank you for writing in. The only thing of “concern” when a patient comes to see me with a history of severe headache which started at the time of coitus is to rule out an aneurysmal bleed. That said and done, mostly this turns out not to be the case and the CT scan and MRI brain/ MRA brain (to look at the blood vessels) comes back negative.
      My advise would be to let your doctor advise you further, if the MRI results come back negative.
      Personal Regards,
      Nitin Sethi, MD

  5. I am a doctor of chiropractic and treat patients with headaches. So when I got a headache 3 days ago during sex I was concerned. I don’t hink I’d ever had a migraine so I thought this must be what one feels like. It was horrendous for a day and then lessened the next 2 days and then resolved. I had sex last night with my wife (thinking I was fine because the headache had resolved)…the headache came back and was as intense as ever. Is it a subarachnoid hemorhage? brain cancer? Being a doctor who is in pain is a bit of a trial because of all we know COULD go wrong. So I called the advise nurse (it was 11pm) ans she put me on to a doctor. He decided rather quickly that I’d better come in right now for a check up at the ER. My dear wife was by my side throughout it all (bless her). I threw up a few times. The hospital gave me morphine and an anti-nauseant. They did a head CT& lumbar puncture both of which were normal. They also did a arteriogram of my neck arteries (caroitids, etc) I believe (remember i was near delerium from the morphine and only wanted to sleep). After much morphine (I had asked them to start small since I don’t drink or smoke–never have) I kept asking for more since it made little affect. Finally they gave me the 6th administeration (I believe) and it helped. I slept for a few hours and they let me leave.
    That’s my story. I guess no sex for a while. I am age 40.

    • Dear Marc,
      Thank you for writing in and sharing your experience. Like I had stated in my post, post coital headache is sudden and severe in onset and hence sometimes called thunderclap headache. When a patient presents to the ER with such a headache it raises alarm and not a few patients end up getting neuroimaging, spinal tap and a few also undergo a formal angiogram to rule subarachnoid hemorrhage caused by a ruptured aneurysm. Everything comes back normal and a diagnosis of post coital headache is made. You can certainly enjoy sex again. I would advice you to speak to your doctor and get his formal advice on the same.
      Personal Regards,
      Nitin Sethi,MD

      • Dear Marc,
        glad you are not plagued by these anymore. You ask a good question whether post-coital headaches come back. I shall have to look into this and get back to you. The patients who I have personally seen with post-coital headaches all had a good outcome and did not have to seek medical attention again.

        Personal Regards,
        Nitin Sethi, MD

  6. Thanks Ashley, I hope you’re right. My first episode of this was friday night, I am a 30 year old healthy guy, normal sex life eat well and all that. Just at the peak moment the occipital region of my head flaired with a sharp grasp throbbing all up my temples. I have been drinking some caffeine and have a history of head injury.

    So when I hear you all talk about this, in the end I am more concerned about the possibility of it recurring. All I can think of is controlling blood pressure. Making sure that area of my body is relaxed and not tense from injury or misuse, which in my case needs attention. Stay hydrated and stop drinking caffeine and alcohol excessively.

    Does anyone have any thoughts on how smoking may effect this?

  7. Hi Mike,

    I just saw your post and wanted to post here and let you know that I have not had any other problems with this. One thing that I found interesting with my situation is that I finally did have an MRI/MRA which came back showing some bone spurs and disk compression in my neck. Degenerative disk disorder, which apparently we will all have at some stage of our life. The doctor thought this could have been a factor with my post coital headache. Fortunately while I still have had a few headaches radiating from the occipital area of my head, I have not had anything similar to what I experienced the first two incidents which led me to multiple doctor appointments.

    When this happened to me it scared the crap out of me and I totally can relate to what you might be feeling. Back then I don’t think anyone could have said anything to make me feel any better but try not to dwell on “worst case scenarios” or “what if it happens forever” …. because odds are in your favor that it will get better and is probably benign. That being said, talk to a doctor if you can…..if only to alleviate your anxiety.

    Good luck.

    Trevor

  8. I am a 52 year old sexually active female. About two weeks ago I had an intense headache or “the worse headache of my entire life” right as I reached orgasm and while it subsided slightly the headache went on for hours……actually made me sick to my stomach. That was the start of it….from then and continuing I have a severe Headache that starts right before orgasm and reaches it highest level of pain right after orgasm… This happens with my partner or when I masturbate alone…. This is scaring me and I have currently given up on sexual activity…someone help please as I am sure that no sex is not the answer to this. I am taking verapamil and atenenol for high blood pressure. Please help

    • Dear Kim,
      thank you for writing. You should bring this is to the attention of your primary care physician so that he can evaluate you. If this does turn out to be post-coital headache, then all that may be needed is reassurance to the benign nature of your symptoms.

      Personal Regards,

      Nitin Sethi, MD

  9. I am so thankful to learn that I am not the only person having this horrible pain. I’m sorry others are experiencing this, but I’m glad I’m not alone. It just started for me about 4 months ago. It has gotten to the point that I am afraid to have an orgasm because the pain is so terrible. It feels as though my head is literally going to burst open. I have to press the top of my head and my forehead as hard as I can for about 10 minutes and then it subsides to a more tolerable degree. I had an MRI yesterday and saw a neurosurgeon today. He said I have a small mass on the bone at the back of my head, near the petuitary (sp?) gland, but this should not be causing me to have the pain during orgasm. He said he thinks it is post coital migraines, and there is medication I can take, but the medication lowers the sex drive and can actually prevent my being able to have an orgasm. Do you have any ideas as to what I might be able to do to minimize or stop the pain and still be able to achieve orgasm?

    • Dear Linda,
      thank you for your email. Benign post coital headaches are also at times referred to as headaches associated with sexual activity. The pathophysiology of these headaches is thought to be migraine like along with a component of muscular (tension) like headache. No treatment is required if the headaches are infrequent. There is no treatment during the acute phase. As a preventive step, sexual activity can be stopped during the bout of headache. Also adopting a more passive role during sex may be helpful. There are anecdoctal reports of using medicines like indomethacin, propanolol, calcium channel blockers and ergotamine in patients who suffer these headaches on a frequent basis. You should talk to your doctor about this. He alone can determine if you warrant treatment and which treatment to take.

      Personal Regards,

      Nitin Sethi, MD

  10. Well, I just got another one and this is my first foray into researching the problem. My first episode was in 2007 at age 26. It continued over a few weeks. The headaches only last a few hours and happen just before orgasm during intercourse and masturbation. I went several years without a recurrence. A few months ago, I had a few more episodes; and again today. I don’t have hypertension and am not on any medications. I am somewhat comforted to know that this isn’t unusual and is most likely benign, but it is sooooo painful. Not to mention a hindrance to my sex life. :(

  11. I have suffered the occasional headache either on orgasm or just before. These were mild and resolved spontaneously or with paracetamol. Recently what I experienced prior to orgasm was like an explosion in my head. I have never felt anything like it. It too resolved itself in a couple of hours. I was however very scared as my father had passed away only months before as a result of a ruptured subarachnoid aneurism. I have since undergone testing, including a CT scan and an MRI which were both clear. I have no medical history to speak of and am on no regular medications. I am worried that this may be a precursor of things to come. With a family history of subarachnoid haemorrahage am I more likely to develp this? and how do I avoid it if diagnostics have not shown anything? Anticipation of another cerebral explosion is also not condusive to romance. Any ideas would be appreciated.

  12. At orgasm I had a sudden and severe worst in my life headache. The pain was in a C shape inside my head on the left side. The headache was constant and non throbbing at a pain level of 9 out of 10. I later had a paralyzed left arm, and later again issues with the tendons behind my knees. I had severe behavioral and mental changes, I was dangerous. After two weeks the headache went from a 9 to a 2 or 3 out of ten, and was mostly replaced by a tremendous pressure in the exact same place and shape.

    Overall the headache lasted 1 1/2 years with out any decrease in pain. The pressure in my head lasted 2 years. And as the pressure slowly reduced in my head, the behavioral and mental issues decreased equally in reference to the pressure.

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