Post-coital headaches and stroke
Sexual activity may, on occasion, be complicated by neurologic syndromes of headache, seizures and amnesia. Orgasmic cephalgia (headaches after orgasm) and post-coital headaches (headaches after sex or even after masturbation) have been reported in the literature from different parts of the world. When doctors see a patient with headaches during or after sexual intercourse, we are most concerned. The most important diagnosis is a type of stroke called subarachnoid haemorrhage. More as you continue, get educated!
Post-coital headache is a recognised presentation of some patients with this type of stroke, due to weakness of a part of the blood vessels in the brain. The vessels burst open due to the stress of the sexual act, leading to bleeding inside the brain. The bleeding causes acute increased pressure in the head; while convulsion and death can subsequently occur.
Many case reports abound in the English literature of post-coital stroke similar to the one in Scotland described earlier. A case of headache associated with sexual activity in a 40- year-old married Indian man was also recently added to the literature.
It is imperative that the condition is highlighted in the media and Nigerians reminded about this presentation of stroke. Many people all over the world have suffered from this type of stroke and have been treated adequately. The patients often present with confusion, nausea, vomiting, seizures, loss of consciousness and severe headache. Timely resuscitation and management can prevent death from this potentially treatable condition and stroke disease.
- post-coital headache
- sexual headache
- orgasmic headache
- coital cephalgia
- coital cephalalgia.
So, a typical story is this. A man or woman is enjoying sex and is just getting to a climax, or has just passed it, when suddenly there's a severe pain, usually located at the back of the skull, just above the neck.
The pain may last for only a few minutes. But sometimes it goes on for several hours, before gradually fading away.
What causes the pain?Very little is known about the causes of this type of pain. But a widespread view among doctors is that it's due to the swift rise in blood pressure (BP) that occurs during sex and, more particularly, during orgasm.
On the other hand, there's no evidence at all that coital headaches are more likely to occur among people who have a high BP (hypertension). Also, they are more common in younger males than older ones, and raised BP less frequent in young men.
Sometimes, orgasm headaches occur when a person is under intense emotional stress.
What is the natural course of events?The headaches may never occur again.
But a more frequent scenario is that they are repeated for a few weeks or months, striking every time the person has sex. Then they gradually fade away.
What should you do about them?Firstly, tell your partner what's happening.
Otherwise, misunderstandings are almost bound to occur because he or she may be confused by the fact that you suddenly 'break off' during sex for no apparent reason and later are reluctant to have any subsequent sexual encounters.
The best immediate treatment is to take ibuprofen, aspirin or paracetamol – provided that these drugs don't give you any problems.
Then just try to relax, lying flat for an hour or two.
My own personal view is that you should let your doctor know what's happened.
I'm possibly being over-cautious here. But when a severe headache occurs at the base of the skull, there's always a chance that it might be due to the well-known medical condition called 'sub-arachnoid haemorrhage' (SAH).
A SAH occurs when there's a small bleed near the base of the brain, under the layer of brain-wrapping known as the dura mater.
The blood loss occurs when a tiny malformation, called a 'berry aneurysm' (which is a bulge in an artery, often about the size of a small blackberry), suddenly starts leaking. It can be treated by surgery.
So, if you get a severe coital headache, let your GP know.
If it's really bad, or if it occurs more than once, your GP may want to refer you to a neurologist. This is particularly likely if you are in the USA, where it's quite common to investigate this pain by doing a CT scan and angiography.
In the UK, it's widespread practice for doctors to advise patients to 'take life easy' for a while, which usually means not having sex for a week or two.
Very frequently, GPs may suggest that the patient uses a painkiller of the type mentioned above, taking it a couple of hours before having sex.
A few doctors prescribe propranolol, which is beta-blocker drug, that has the effect of lowering blood pressure and slowing the pulse, as well as reducing anxiety.
Looking on the bright side, very often these coital headaches just 'fade out' over a period of weeks or months, and never recur.
But I do feel that it's worth seeking medical advice, just in case there's any serious underlying medical condition.