Headaches during sex likely more common than reported

About 1 percent of adults report they have experienced headaches associated with sexual activity and that such headaches can be severe.

But the actual incidence is almost certainly higher, according to a Loyola University Medical Center neurologist and headache specialist.

"Many people who experience headaches during sexual activity are too embarrassed to tell their physicians and doctors often don't ask," said Dr. José Biller, who has treated dozens of patients for headaches associated with sexual activity (HAS). Biller is chair of the Department of Neurology with the Loyola University Chicago Stritch School of Medicine, and is certified in Headache Medicine by the United Council for Neurologic Subspecialties.

Comedians have long joked about spouses avoiding sex by claiming to have a headache. But sex headaches are not a laughing matter, Biller said.

"Headaches associated with sexual activity can be extremely painful and scary," Biller said. "They also can be very frustrating, both to the individual suffering the headache and to the partner."

Headaches usually are caused by disorders such as migraines or tension. But headaches also can be secondary to other conditions, and some of these conditions can be life-threatening.

The vast majority of headaches associated with sexual activity are benign. But in a small percentage of cases, these headaches can be due to a serious underlying condition, such as a hemorrhage, brain aneurysm, stroke, cervical artery dissection or subdural hematoma. "So we recommend that patients undergo a thorough neurological evaluation to rule out secondary causes, which can be life-threatening," Biller said. "This is especially important when the headache is a first occurrence."

Sexual activity is comparable to mild- to moderate-intensity exercise. The ancient Greek physician Hippocrates first noted the association between headaches, exercise and sexual activity. And in 2004, the International Headache Society classified HAS as a distinct form of primary headache.

Biller said men are three to four times more likely to get HSAs than women. There are three main types of sex-related headaches:

• A dull ache in the head and neck that begins before orgasm and gets worse as sexual arousal increases. It is similar to a tension headache.
• An intensely painful headache that begins during orgasm and can last for hours. It's called a thunderclap headache because it grabs your attention like a clap of thunder. One of Biller's patients, who asked to remain anonymous, described such a headache this way: "All of a sudden, there was a terrific pain in the back of my head. It like someone was hitting me with a hammer."
• A headache that occurs after sex and can range from mild to extremely painful. The headache gets worse when the patient stands and lessens when the person lies back down. This headache is caused by an internal leak of spinal fluid, which extends down from the skull into the spine. When there's a leak in the fluid, the brain sags downward when the patient stands, causing pain.

Depending on the type of headache, certain medications can help relieve the pain or even prevent the headache, Biller said.

Individuals can reduce their risk of sex headaches by exercising, avoiding excessive alcohol intake, keeping a healthy weight and counseling, Biller said.