Why some people develop headaches during sex –Neurologist

A Professor of Clinical Neurology and Internal Medicine at the College of Medicine, University of Nigeria, Enugu, Ikenna Onwuekwe, has said that people with existing headaches are often more prone to having headaches when having sexual intercourse.

The health urged people who experience headaches during sex not to take it lightly but rather seek medical intervention from specialists.

According to the neurologist, people who have migraine, tension, medications, or fevers often experience a worsening of their headache when they engage in sex.

Prof. Onwuekwe, however, noted that some people without already existing headaches also experience headaches with the onset of sex, before orgasm, or after orgasm. 

Onwuekwe, who is also the head of the Neurology Unit and Consultant Neurologist at the University of Nigeria Teaching Hospital, Enugu, explained that since there are possibly confusing reasons for sex to cause headaches, anyone having such must be seen by a competent Neurologist and Headache Specialist for proper diagnosis and treatment.

Speaking in an interview with PUNCH HealthWise, the don said sexual intercourse is a demanding physical activity, adding that it can be associated with the start of or worsening of an already existing headache.

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He stated that the 2018 International Classification of Headache Disorders recognises the disorder called primary headache associated with sexual activity. 

“This primary disorder serves to distinguish it from headache due to other causes such as migraine that can be made worse during or secondary to sexual activity.

“Because sex is a demanding physiological activity, people with already existing headaches from migraine, tension, medications, or fevers may experience a worsening of their headache if they start or engage in sex.

“The primary headache associated with sexual activity describes people who only get a headache with the onset of sex, before orgasm, or at orgasm. 

“Such people must not have any prior existing headache condition,” he said.

According to him, for a few people who experience headaches post-orgasm, it may be due to issues with cerebrospinal fluid leakage.

A cerebrospinal fluid leak is when you’re leaking the fluid that surrounds your brain and spinal cord. CSF is vital to how your brain and spinal cord work, protecting and cushioning them from outside forces, Cleaveland Clinic said.

Continuing, the neurologist said for primary headache associated with sexual activity, the headache may be severe in intensity for one minute to 24 hours duration or of mild intensity for up to 72 hours. 

He said that while there is no accurate data for this condition in Nigeria, about one per cent of the general population worldwide is estimated to have primary headaches associated with sex, adding that men are at greater risk than women.

He added that the typical age of presentation is between 20 – 45 years. 

“By way of the cause of this primary headache of sexual activity, the exact reason is unsure though factors associated with haemodynamic instability are incriminated. 

“It is known that during sexual activity, the Valsalva maneuver occurs and there are robust increases in blood pressure of these sufferers during sex much more than is seen in healthy controls and people with migraine. 

“Systolic blood pressure can shoot up to as high as 160-170mmHg or more in this condition.

“Typically, the headache will repeat with recurrent sexual activity but 15 per cent of cases may have remissions lasting two months at a time in-between attacks. A chronic cause is well recognised.

“In every case of headache brought on by or worsened during sex, it is important to distinguish primary headache (without any other evidence associated condition that can cause headache) from secondary headache syndromes where potentially lethal conditions may exist such as brain aneurysms or tumours or stroke with bleeding into the brain.”

“Another condition that may look like primary sexual headache is called reversible cerebral vasoconstriction syndrome where selected arteries at the back of the brain get temporarily blocked by spasm. This can occur during sex or any exercise but it is not a primary headache associated with sex.

On the diagnosis, he said apart from detailed clerking and examination, neuroimaging modalities and examination of cerebrospinal fluid amongst other investigations may be needed to arrive at the specific disorder and to establish the diagnosis of a primary or a secondary headache syndrome.

He said treatment varies according to the specific cause. 

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“For some people, the Neurologist may recommend reducing the frequency of sex while for others, there may be a need to adopt more passive sex positions and use recumbent postures more often.

“People with hypertension need to be properly controlled on medications and the use of certain drugs that enhance sexual function but cause vasodilation of blood vessels must be strictly regulated. 

“For candidates diagnosed to have primary headache associated with sexual activity, certain medications are useful such as indomethacin and propranolol among others.

“In all cases, there is a need to stress the critical need for the headache expert to guide the identified sufferer to ensure best practices and better quality health including satisfactory sexual health.

“So many cases have come to public knowledge about people found to have collapsed and died in bedrooms at home and in hotels during sex activity.

These are not usually cases of primary headaches associated with sexual activity but likely cases of lethal consequences of secondary headaches associated with sexual activity. 

“In these latter cases, at the height of orgasm or with increasing intensity of sex, there is either a massive acute coronary event such as myocardial infarction (heart attack) or a massive intracranial event such as a large cerebral haemorrhage.”

The expert noted that to have satisfactory and safe sexual life, it is vital to have a clean bill of health, to know one’s health risks, and have them controlled by a competent physician.

“Otherwise, one can sometimes pass on to the other side while in active pleasurable service.

“For those known to have a diagnosis of primary headache associated with sexual activity and it happens frequently, the headache can be prevented by taking medications like indomethacin or beta-blockers minutes before the onset of sex.

“But it must be stressed that there is no room for self-prescription here. Expert neurological management is key,” Onwuekwe said.