Primary headache associated with sexual activity (Orgasmic and Pre-orgasmic Headache)

The Basics

Primary headache associated with sexual activity, previously known as orgasmic or pre-orgasmic headache, is a rare headache type brought on by or occurring only during or after sexual activity.

Primary headache associated with sexual activity is termed “primary” because it’s not caused by another condition or disorder. People with new or never-evaluated headache associated with sexual activity should be carefully assessed by their doctor for an underlying cause and considered for imaging of their brain and the blood vessels in their head to exclude conditions like subarachnoid hemorrhage, arterial dissection and reversible cerebral vasoconstriction syndrome.

Primary headache associated with sexual activity is commonly described as bilateral (on both sides of head) and often located occipitally (back of the head). Primary headache associated with sexual activity generally lasts from 1 minute to 24 hours with severe pain and up to 72 hours with mild pain. It may have similar features to migraine and must be distinguished from migraine triggered by sexual activity. Primary headache associated with sexual activity can occur at any sexually active age and is more common in males than in females. Previously, primary headache with sexual activity was sub-classified into:

  • Pre-orgasmic headache (classically described as a dull, usually occipital pressure pain that appears during sexual activity and increases with mounting sexual excitement)
  • Orgasmic headache (classically described as a sudden explosive headache followed by severe throbbing head pain that occurs just prior to or at the moment of orgasm)

Please refer to the International Classification of Headache Disorders 3rd edition website for more information on the criteria used to diagnosis primary headache associated with sexual activity.

Treatment

Studies have shown that up to 40% of all cases of primary headache associated with sexual activity run a chronic course over more than a year.

Treatments that have been used for primary headache associated with sexual activity include indomethacin, triptans and propranolol. Thorough investigations to rule out potential secondary vascular lesions must be completed prior to initiating these treatments, as indomethacin is an NSAID, which can affect blood clotting, and triptans can be vasoconstrictive.

Summary

Primary headache associated with sexual activity is more common among men than women. When diagnosing, care must be taken to rule out other, more serious conditions such as subarachnoid hemorrhage, arterial dissection and reversible cerebral vasoconstriction syndrome. Treatment, when necessary, is usually indomethacin and/or propranolol.

Resources:

The International Headache Society. https://www.ichd-3.org/other-primary-headache-disorders/4-3-primary-headache-associated-with-sexual-activity/

Frese, A.; Rahmann, A.; Gregor, N.; Biehl, K.; Husstedt, I-W; Evers, S. “Headache associated with sexual activity: prognosis and treatment options.” Cephalalgia, 2007, 27, 1265–1270