Q. I have a problem my doctor and neurologist can’t help me with. I am hoping you can give me a hint as to what to do.
Whenever I strain in heavy lifting or in hanky panky (don’t laugh), I get severe pounding headaches lasting 5 to 15 minutes. I am incapacitated by them. My neurologist says they are “benign sex headaches” caused by my blood pressure going high, but I’m on Accupril for hypertension. Do you have any ideas? I would like a normal life back.
A. You are not alone in your distress. Here is a story from another person with this problem:
“Thank you for your article about sex headaches. My doctor thought I was nuts when I complained of a similar problem. It happens only when I’m on top. This position gives me the most pleasure, but I have been avoiding it for fear of a stroke. The only other time I had such a headache was after going down a steep water slide. My kids and husband were terrified I was dying.
“I am a 49-year-old woman with high-normal (130/80) blood pressure. I take naproxen for arthritis and Zyrtec for allergies. The headache is explosive and excruciating. At least your article vindicates me and assures me I am not alone!”
Have a specialist evaluate your headaches. If they are “benign sex headaches” similar to those suffered by the reader who wrote to us previously, there are a number of treatments. For example, the naproxen you use for arthritis may prevent such headaches if taken before lovemaking.
It is extremely important to rule out other potential causes of severe headaches. One woman responded to the same letter:
“I read with great concern your column about the man who asked for help with headaches that occurred with exertion or sexual activity.
“When my husband was 25, he had a very similar headache while having sex. The doctors told him it was viral. After a week of bed rest and Tylenol he felt better and went back to work. The next week while having a bowel movement it recurred, but this time the headache was fatal. He had a ruptured aneurysm in his brain. Please tell your readers to rule out all possibilities of problems with blood vessels.”
Two kinds of headache are associated with sexual activity and exertion. One develops gradually with a dull, throbbing ache at the back of the head. The other type is explosive and excruciating, starting just before or during orgasm and lasting 5 to 15 minutes.
Neurologists often prescribe NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin IB), naproxen (Aleve) or indomethacin (Indocin) to be taken prior to love-making. An alternate approach is the blood pressure pill propranolol (Inderal) as a preventive measure. You might want to consult a headache specialist and ask if such treatment would be appropriate in your case. But please make sure to rule out anything serious that might require more aggressive treatment.
For those who would like to learn more about headaches and migraines we offer our Guide on this topic. If you have ever experienced a sex headache like those reported here, please add your story in the comment section and let us know what has helped you.