Headaches during sex sound like a joke, but they are not funny to anyone who experiences them. Mysteriously, the headache may occur on some occasions but not on others, even with the same sexual technique. Sexual intercourse, or just masturbation, may bring on the pain.

Who gets headaches during sex?

• Sexual headaches can occur at all ages, but are most common in the early 20s and between 35–45 years of age (Neurology 2003;61:796–800).
• Men are three times more likely than women to have sexual headaches.
• Sexual headaches tend to occur during male, but not female, orgasm, and during female but not male masturbation.
• Sexual headaches are also more common in people who already suffer from migraine or tension headache.

Why the headache occurs
Sex can cause various sorts of headache.

• At the moment of orgasm there can be a sudden, severe pain. This is probably due to contraction of some of the small blood vessels in the brain, similar to migraine, and in fact half the people with this type of headache are also migraine sufferers. This pain generally lasts less than an hour, but may be gone in 10 minutes or linger for a few hours. It may be throbbing, dull or stabbing.
• Less commonly, as sexual excitement increases, some people experience a dull, cramping, tight feeling at the back of the head. This is probably due to excessive contraction of the muscles of the neck.
• If you suffer from migraine, you may find that sex triggers a migraine attack. This headache will be identical to your ‘usual’ migraine. It occurs after sex, but not during sex.

Some people have only one of these headaches, but many people have a combination, so they experience a headache that increases with sexual excitement, and culminates in an explosive headache at orgasm.

Often, the headaches occur in bouts lasting a few weeks, and then disappear for a while.

Other causes of headache during sex are pills for the treatment of erection problems, such as Viagra (sildenafil), Cialis (tadalafil) and Levitra (vardenafil). Headache is one of their side effects.

What you can do about it

• If you have severe headache at orgasm, you must see your doctor to check that there is no serious reason for the headache. A brain scan is recommended as a precaution (Update 2006;73(2);10). Your doctor may then be able to prescribe a drug such as propranolol to prevent the headache.
• If you mainly have the dull headache at the back of the neck, make a deliberate effort to relax your neck muscles. This usually relieves it.
• Try intensifying your sexual excitement more gradually. This works in about 50% of men with sexual headache.
• Most people find they are more prone to these headaches when they are tired or under stress, attempting intercourse for the second or third time in close succession, or when they are using an uncomfortable or strenuous position. Try to avoid these situations!
• Sexual headaches are also more likely if you are in poor physical shape, overweight and with high blood pressure – so if you become fitter they may improve.