Q. Sometimes when my husband and I make love I get an excruciating headache at climax. It lasts only a few minutes, but it is so painful I am nervous about having sex.

I asked my doctor, who said sex headaches are nothing to worry about. My husband is understanding but disappointed, and I can’t ask him to accept this situation indefinitely.

The doctor didn’t offer any solution. Is there something I could take to prevent these headaches?

A. Doctors call your condition HSA (headache associated with sexual activity). It requires a complete medical workup (CT scan, MRI, etc) by a neurologist to rule out any serious underlying problem.

Such headaches may consist of a dull pain that gradually worsens during sex. Another type more typically begins suddenly at the moment of orgasm. Three times more men than women report these headaches (Neurology, Sept. 2003).

Your doctor may consider prescribing preventative medication such as a beta-blocker (for example, atenolol or propranolol). Some physicians prescribe indomethacin or a similar anti-inflammatory pain reliever to be taken an hour beforehand to prevent HSA.

Q. I stay active playing golf and swimming, but I have trouble sleeping. I have taken Ambien for several years, but my doctor doesn’t want me to take it any more.

I have arthritis, bursitis and fibromyalgia, so I have a terrible time getting to sleep. Would hypnosis help me sleep?

About 40 years ago, my doctor used hypnosis with me before I went to the dentist. I could numb my own gums. But I tried it for sleeping and I cannot do it again by myself. Do you know of any sleep hypnosis tapes to buy?

A. Auto-hypnosis might well help you get to sleep, without side effects. Dr. Emmett Miller has some of the best audiotapes for this purpose.

Getting a good night’s sleep is essential for people like yourself who suffer from chronic pain. Experts believe that the lack of restorative sleep contributes to the symptoms of fibromyalgia.

For more information about sleep medication such as Ambien as well as relaxation tapes and other non-drug approaches, we are sending you our Guide to Getting a Good Night’s Sleep along with a one-hour CD of our radio show with sleep expert Martin Scharf, Ph.D. Anyone who would like copies, please send $15 in check or money order to Graedons’ People’s Pharmacy, No. CD-70, P. O. Box 52027, Durham, NC 27717-2027.

Q. I have heard that women taking birth control pills need to be aware that antibiotics could reduce their effectiveness. I have had a similar experience with antibiotics and hormone replacement therapy. While I was on an antibiotic, my HRT stopped working and the miserable symptoms reappeared in full force. Is there a type of antibiotic that does not affect birth control pills or HRT?

A. The interaction between antibiotics and birth control pills remains controversial. Some experts downplay its significance, while others maintain that antibiotics can counteract contraceptive efficacy, leading to unwanted pregnancies.

We have not heard of interactions between antibiotics and hormone replacement therapy. The hormones used, however, are similar to those in birth control pills, so in theory HRT might well be affected.

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