Headaches that mean it's MEN saying: Not tonight darling!



23:42 GMT, 17 December 2012

What should have been a pleasurable moment for Will Ashton turned to agony.

For while he was making love with his girlfriend, he was suddenly struck down by a devastating headache.

‘It was like a sledgehammer had smacked me in the back of my head,’ recalls Will, 31.

Benign sexual headaches were first identified by doctors in the Sixties, yet the reason people are affected is not completely understood

Benign sexual headaches were first identified by doctors in the Sixties, yet the reason people are affected is not completely understood

‘I collapsed on the bed, groaning and in shock. I couldn’t open my eyes, and I felt dazed for about 30 seconds.’

The intense pain eased afterwards, but he was left with a lingering, dull headache.

When he was still suffering from it two days later, Will went on to the internet for a diagnosis, where he discovered the likely cause — coital cephalgia, or headaches caused by sexual activity.

He went to his GP who, while agreeing this was the likely explanation, as a precaution sent him to A&E to be checked out for potentially life-threatening conditions, such as a brain haemorrhage.

‘It was pretty scary,’ recalls Will, a media executive from North London.

‘I had to have a lumbar puncture and a brain scan, but thankfully the next day doctors told me it wasn’t a brain haemorrhage.

'They explained the headache was brought on by sex, but that it wasn’t dangerous. That’s when everything fell into place.

‘I’d had shorter, mild headaches during sex before — they build up a few seconds before orgasm — but nothing as extreme as that.

‘I never made the connection until that point because the headache didn’t happen every time, and when it did, I just put it down to exertion.

'The doctors were very reassuring and explained it’s nothing to worry about. I was relieved to know the truth.’

Incredibly, one in every 100 people is thought to experience coital cephalgia, also known as benign sexual headaches, although experts say the true figure is likely to be higher as many sufferers feel too embarrassed to visit their doctor.

‘This is a hidden epidemic,’ says Dr Andrew Dowson, director of headache services at King’s College Hospital, London.

‘Sufferers don’t want to discuss their symptoms because they’re embarrassed.

'People might laugh about headaches and orgasm, but they can cause real distress and affect relationships.

'The patients we’re seeing are just the tip of the iceberg.’

Sufferers can experience sexual headaches off and on for months or years, but eventually they tend to disappear on their own

Sufferers can experience sexual headaches off and on for months or years, but eventually they tend to disappear on their own

More prevalent in men (by a ratio of 3:1), the most common age to experience them for the first time is in your early 20s, or between 35 and 44.

Doctors are unable to explain why men or those in the typical age brackets are more likely to suffer, as not enough research has been conducted into the condition, but those who have migraines appear to be more at risk.

Sufferers experience either a ‘pre-orgasmic headache’ — a dull ache that gradually builds up — or an ‘orgasmic headache’, with sudden severe pain at the moment of climax.

Orgasmic headaches are usually characterised by a severe pain at the base of the skull, moving to the front of the head, coupled with sharp throbbing behind the eyes.

They typically last from a few minutes to a few hours, though it is possible for such headaches to last for days.

Sufferers can experience sexual headaches off and on for months or years, but eventually they tend to disappear on their own.

Just as doctors are not clear on why these headaches begin, the reason they end is also not yet known.

According to Dr Mark Weatherall, consultant neurologist at Princess Margaret Migraine Clinic, Charing Cross Hospital, it’s the immediate orgasmic headache that could spell danger.

‘The difficulty with an explosive headache at orgasm is that we can’t distinguish whether the symptoms are due to this benign condition or something more serious.

'Some people have an underlying brain aneurysm, which is a bulge in a blood vessel, caused by a weakness in the vessel wall.

‘When their blood pressure goes up during sex, there’s a risk that the aneurysm will rupture.

'This causes what’s called a sub-arachnoid haemorrhage — basically, a bleed on the brain.

‘Our advice to anyone who experiences a sudden, severe headache at orgasm is to get it checked out by a doctor immediately.

'In most cases, these headaches are not dangerous, but it’s important to rule out more serious causes.’

Benign sexual headaches — those not related to serious health conditions — were first identified by doctors in the Sixties, yet the reason people are affected is not completely understood.

Genetic influences have been suggested, with one medical study describing four sisters who each experienced the problem.

Reports also suggest that frequent migraine sufferers may be more likely to experience the condition.

This may be because benign sexual headaches could be linked to the nervous system controlling blood flow — the same mechanism is thought to be behind migraine.

‘There’s a school of thought that says these headaches are linked to how the nervous system controls the opening and closing of blood vessels,’ says Dr Brendan Davies, consultant neurologist at the North Midlands Regional Headache Clinic.

‘When people experience benign sexual headaches it’s thought blood vessels in the brain are in spasm. Interestingly, some, but not all, people who get headaches during sexual activity also get what are called exertional headaches when they’re exercising.

‘We don’t really know why this is, but it may be due to the way certain areas of the brain that control pain switch on or off.’

In Dr Davies’s experience, men are more reticent than women to talk about it.

‘Funnily enough, though, once these patients get it out in the open, they tend to feel very relieved,’ he says.

Once more serious underlying causes have been ruled out, the emphasis for patients is on controlling the headaches through medication.

The beta blocker propranolol or the anti-inflammatory drug indomethacin can be taken as a preventative measure shortly before sex, or daily for long-term prevention.

Both these drugs are sometimes prescribed as a treatment for migraine.

While most patients generally get on well with both drugs, propranolol sometimes causes side-effects such as erectile dysfunction and loss of libido, as well as fatigue and light-headedness.

Those taking indomethacin occasionally experience dizziness and digestion problems, although gastric protection medication can also be taken to counteract this.

Another option is the migraine treatment naratriptan (a serotonin trigger used to treat migraine).

Alternatively, some doctors suggest taking a low 75mg dose of aspirin daily to prevent the headaches occurring.

There is also the option of avoiding sexual activity altogether until the headaches disappear, which, as Dr Davies admits, isn’t always attractive to patients.

‘For most people, completely stopping sex is a no-goer,’ he says.

‘Instead, data suggests indomethacin is effective in treating these headaches, and reports have also shown naratriptan may also be beneficial.

'However, having to take tablets before sexual activity may in itself affect the libido and cause problems.’

Fortunately, the general prognosis for sexual headache sufferers is largely positive.

‘The good news is these headaches often go away by themselves,’ says Dr Davies.

The real issue for sufferers lies in overcoming their awkwardness in discussing intimate sexual details with their GP.

In Will’s case, his diagnosis five years ago has made a positive difference.

‘I feel better about my condition since I had my health scare,’ he admits.

‘At least I know what the headaches are now, and I’m armed with the knowledge so there’s no need to panic.’

Two weeks after his first major headache, Will was referred to a neurologist who prescribed indomethacin and advised him to stop sex immediately when he felt a headache building.

‘They told me to take the tablets half an hour before sex, and that was great and reassuring the next few times,’ he says.

‘But having to take a pill before sex does kind of kill the spontaneity, so I don’t use them any more.

Since then I’ve had the odd strange, dull pain in the lead up. I try to stop when I feel it coming on, but I don’t always get much warning.’

Five years on and happily married, Will hasn’t had a sexual headache for 12 months, and hopes they have stopped altogether.