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Primary Sexual Headaches - Not a Joke! Information, Symptoms, and Causes

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Medically Reviewed by Dr Danae Maragouthakis

Sex is supposed to be a pleasurable experience. But when a headache comes out of the blue whilst you’re having a great time, it can ruin everything.

Are you having headaches during sex or right before orgasm? If so, you’re not alone! In fact, 1 in 100 people get headaches associated with sexual activity!

But what causes these headaches, and how can you prevent them?

In this article, we’ll go over what primary sexual headaches are, some common causes, and how to prevent them.

What Is a Primary Sexual Headache?

A primary sexual headache associated with sexual activity (PHASA), also known as a sex headache, is just what the name suggests. Sexual activity—especially orgasms—can cause you to have a headache, whether it’s before or during sex.

During sex, you might notice a dull ache in your head and neck as sexual excitement increases. In other cases, you might experience a sudden, severe, throbbing headache just before or during an orgasm.

Some sex headaches can last a few minutes, while others can linger for hours or even days.

According to the National Health Service (NHS), sex is one of ten common headache triggers - and no, it’s not just an excuse! Doctors theorise that these headaches are caused by pressure build up in the head and neck muscles, which is likely related to tension.

Sex headaches simply caused by muscle tension are not a major cause for concern. And while they’re uncomfortable and inconvenient, they’re usually harmless, and they certainly don’t mean you have to avoid sex!

More rarely, however, a sex headache can be caused by life-threatening problems with the blood vessels in the brain. Sex headaches in these circumstances are medical emergencies which require urgent attention. So, whilst most sex headaches are benign, there are a few serious causes which require immediate medical review.

What Causes Sex Headaches?

Sex headaches can occur as a result of any type of sexual activity.

There are many causes of primary sex headaches. In most cases, these headaches are relatively benign, and aren’t caused by a life-threatening illness. For example, if you’re regularly experience sex headaches that build slowly, you might have a primary headache disorder that’s not associated with any underlying condition.

However, if for the first time, your headache comes on suddenly during sex, you may have something more serious going on. Possible causes include:

  • Primary sex headache: Refers to sex headaches that don’t have a clear underlying cause. The exact reason why these headaches occur isn’t known. They could be due to physiological changes that occur during sexual activity, such as increased tension from excessive contraction of neck and jaw muscles, or changes in blood flow to the brain.
  • Subarachnoid haemorrhage: Bleeding in the brain, which can occur when a blood vessel in the brain ruptures. As a result, you might experience a sudden, severe headache alongside other symptoms that aren’t typically associated with primary sex headaches.
  • Intracranial aneurysm: A weak spot on an artery in the brain that fills with blood.
  • Arteriovenous malformation: A tangle of blood vessels in the brain.
  • Intracranial dissection: A tear in the lining of an artery in the brain.

Other causes of sex headaches include:

Risk Factors

There are a few risk factors that might increase your chances of having benign sex headaches. For example, men are four times more likely to have orgasm headaches than women. You might also be more likely to have sex headaches if you have a history of migraines.

Types of Primary Sex Headaches

There are two main types of primary sex headaches which differ in terms of when they present and the nature of the headache:

  • Pre-orgasmic headache: Refers to a headache that occurs during sexual activity but prior to orgasm. With this type of headache, you might experience a dull pain at the back of your head on both sides, which gradually gets worse as you near climax. Pre-orgasmic headaches typically last between 5 minutes and one hour.
  • Orgasmic headache: This is the most common type of primary sex headache and refers to a headache that occurs during orgasm. With this type of headache, you might experience a sudden, explosive pain which lasts for up to 30 minutes before slowly subsiding into a dull throbbing that can linger for up to four hours, and in some cases three days!

The symptoms of sex headaches differ according to their cause. But in general, if you experience any other symptoms during a sex headache, then it could be due to an underlying condition.

Concerning symptoms that may accompany a sex headache and could indicate something more serious include:

  • Loss of consciousness: Bleeding or blood clots in the brain could cause you to pass out.
  • Nausea or vomiting: Bleeding in the brain increases the pressure in your skull and may cause you to experience nausea or vomiting.
  • Neck pain or stiffness: Bleeding in the brain or dissection of arteries that supply the brain may cause your neck to hurt or feel stiff.
  • Double vision: If there’s damage to the nerves that play a role in moving the muscles that control eye movements, you might experience double vision.
  • Numbness or weakness: Bleeding or blood clots in the brain can cause numbness and weakness in other areas of the body.

How Can You Treat or Manage Sex Headaches?

Sometimes your first sex headache is also your last. Plus, some headaches go away quite quickly - before any pain relief has kicked in or even before you reach for a pill in the first place.

However, if your sex headaches come on often or last a while, there are different medications you can take to manage your symptoms.

Preventative Medications
  • Occasional medications: You can take Triptan—a medication used to treat migraines—before or after sex, allowing you to tackle a sex headache before it happens or gets worse. Taking an NSAID, like ibuprofen or indomethacin, 30 to 60 minutes before intercourse can also ease sex headaches.
  • Daily medications: If you have an underlying condition that’s causing your headaches, you might take daily medications to keep things under control. For example, beta-blockers, such as propranolol or metoprolol can treat high blood pressure, coronary artery disease, and migraines.

When Should You See a Doctor?

Primary sex headaches are usually harmless, and most don’t warrant a trip to the doctor. However, the first time you experience a sudden onset, severe sex headache, or if you experience a sex headache in the presence of other symptoms, you should seek urgent medical advice to exclude a potentially life-threatening emergency. If you start developing sex headaches more frequently, you should speak with your doctor, as they may help organise investigations to identify an underlying cause.

All in all, sex headaches aren’t funny, no matter how much the age old adage rings true. And while most headaches brought on by sex are generally considered harmless, it’s important to remember - when in doubt, get checked out!

Looking for more information on how to have a healthier sex life? Visit our Support & Advice page.

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