It’s a common reason to give if you’re just not in the mood for between-the-sheets action. “Not tonight. I have a headache,” is a pretty effective mood-killer. But what if it’s not an excuse, but a serious health issue?
For one in 100 people, coital cephalalgia — also known as primary sex headache or headache associated with sexual activity — makes sex painful. According to Patient, there are two types of primary sexual headache: early coital cephalalgia and orgasmic coital cephalalgia.
Early coital cephalalgia is typically a dull, cramping pain occurring before orgasm and intensifying as sexual arousal increases. it is believed to relate to an excessive contraction in the head and neck muscles prior to orgasm. Orgasmic coital cephalalgia is more common and more severe, although it doesn’t last as long (around 15 minutes on average). It occurs during orgasm and presents itself as a sudden, extreme throbbing headache.
Additionally, a secondary sex headache known as late coital cephalalgia may occur after sex, causing extreme discomfort when standing, and can only be lessened when the sufferer lies back down. This type of headache associated with sexual activity can last for several hours or even days in extreme cases.
Anyone can experience headache associated with sexual activity, but being prone to migraines increases your risk of getting one, and men are three to four times more likely to suffer than women, possibly because men may exert themselves more during sex.
The last thing we want from sex is a headache, right? So what causes coital cephalalgia, and just how serious is it? Step forward neuroscientist in sexuality, Nicole Prause (who also used to work in a specialty headache clinic, so we can’t think of anyone better qualified to advise on this particular issue.)
“Headache after intercourse, masturbation or orgasm is very rare and tends to be rapid-onset and short-duration, making efforts to pinpoint a single cause very difficult,” Prause told SheKnows. “It is most likely related to simple exertion, just like from exercise, in most cases. So far as we know, there is nothing special about sex that promotes headache.”
While any rapid-onset head pain could signify a more serious condition, such as a hemorrhage, if a headache is experienced regularly during sex, it’s unlikely to be life-threatening. That doesn’t mean it’s not a threat to your sex life, but there are ways to relieve head pain following sex, masturbation or orgasm.
“You can treat prophylactically [take pain medications prior to starting sexual activity], but if the headaches are infrequent and not too severe, waiting to medicate until first pain is a likely a better strategy to avoid rebound headaches in the future,” advised Prause. “Also, consider the positions during intercourse. Posture can most certainly contribute to headaches. For a female-with-male partner, try straddling him over an armless chair to avoid shifting from laying to sitting positions rapidly.”
The good news is that experimenting with different sex positions and habits could be the key to figuring out how to stop primary sex headache.
“It may be that being sexual at a different time of day, using different positions or testing your headache propensity with exercise at a similar time of day to when you are having sex can identify what aspect triggers your headaches,” said Prause. “This could allow you to modify sex to reduce the chances you will end up with a headache, such as by having sex before dinner rather than after!”
As with all health issues, make an appointment with your doctor if you have concerns about primary sex headache.
A version of this story was published March 2017.
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