Head, Ache, and Orgasm

When sex and pleasure turn painful

By Lucio Victor Jr.

Medical literature abounds with data on headaches that occur during certain circumstances. For instance, headaches not associated with structural lesions may be triggered by cold, cough, physical exertion, or even sexual activity.

    According to the National Headache Foundation, headaches associated with sexual activity may be classified under two categories: orgasmic cephalalgia or coital cephalalgia. Harrison's Principles of Internal Medicine writes that headaches associated with sexual activity affect four men for every one woman. Sudden in onset, attacks occur periorgasmically and subside in minutes if the sexual activity is interrupted.

    Be it orgasmic cephalalgia or coital cephalalgia, headaches associated with sexual activity are benign in nature, explains Dr. Perry Noble, neurology consultant at the Makati Medical Center. He notes that these headaches are not commonly encountered, and observes that in clinical practice some patients are shy or modest to associate their headache with sexual intercourse. This means the clinician has to probe further before a satisfactory history and diagnosis could be obtained.

    The more popular of the two, orgasmic cephalalgia (a.k.a. orgasmic headache or benign coital headache), is a type of vascular headache that occurs right before and during orgasm regardless of how vigorous the sex may be. This is described as an intense, severe headache manifesting with periorbital or retroorbital pain or both that persists for a few minutes and may continue for several hours. It has been observed that staying still while having this headache limits the pain.

    Coital cephalalgia, on the other hand, is more of an exertional headache that occurs during sex. It develops when the blood vessels of the brain dilate and the muscles of the head contract as a result of building excitement in preparation for orgasm. This is usually a benign headache that is rarely associated with a serious pathology.

    Dr. Noble explains that during preorgasmic phase of coitus, blood pressure, heart rate, respiratory rate, temperature, and oxygen demand rise. All these changes eventually result in traction on the pain-sensitive areas of the brain to cause the pain. Pain sensitive structures in the brain are: scalp, middle meningeal artery, dura, falx cerbri, and proximal segments of the large pial arteries.

Make Sure About It

    Before treating these types of headaches, a doctor must first make sure these are not actually headaches symptomatic of a more serious problem. Organic pathologies like a ruptured aneurysm, subarachnoid hemorrhage, tumors or arteriovenous malformations may manifest with headache and can be the underlying cause. Dr. Noble says that not a few afflicted individuals actually suffer from migraine.

    Treatment depends on the nature of the headache. Dr. Noble says that headaches associated with sexual activity among migraine sufferers will be treated like migraine. Preventive treatment may be initiated as the headache may likely strike again with another coitus. He adds that orgasmic cephalalgia may be a form of migraine although not all migraine sufferers end up having orgasmic cephalalgia. Symptomatic treatment for the headache may be achieved with the use of nonsteroidal antiinflammatory drugs (NSAIDs) or analgesics.