Bóle głowy podczas seksu – Patofizjologia i mechanizm

Bóle głowy podczas seksu
Patofizjologia i mechanizm

Ból głowy związany z aktywnością seksualną (PHASA) to pierwotny ból głowy, który pojawia się podczas aktywności seksualnej, nasilając się wraz ze wzrostem podniecenia lub nagle w momencie orgazmu. Patofizjologia PHASA jest wieloczynnikowa i obejmuje mechanizmy naczyniowe, takie jak gwałtowny wzrost ciśnienia tętniczego (o 40-100 mmHg skurczowo i 20-50 mmHg rozkurczowo podczas orgazmu) prowadzący do rozszerzenia naczyń mózgowych, zaburzenia autoregulacji naczyń mózgowych, napięcie mięśni szyi i głowy oraz nadmierną aktywację układu współczulnego. Współistnienie PHASA z migreną (25-47% pacjentów) i bólami głowy wysiłkowymi sugeruje wspólne mechanizmy patofizjologiczne, w tym zwiększone ciśnienie śródczaszkowe i nadwrażliwość neuronalną. Rola neurohormonów, takich jak prolaktyna i peptyd związany z genem kalcytoniny (CGRP), jest szczególnie istotna u kobiet, co może tłumaczyć różnice płciowe w występowaniu PHASA.

Bóle głowy podczas seksu: Patogeneza i mechanizm

Ból głowy podczas aktywności seksualnej (ang. Headache Associated with Sexual Activity, HAWSA) towarzyszy ludzkości od czasów starożytnych, jednak dopiero od lat 70. XX wieku stał się przedmiotem szerszego zainteresowania naukowego. Obecnie w literaturze medycznej określany jest jako pierwotny ból głowy związany z aktywnością seksualną (ang. Primary Headache Associated with Sexual Activity, PHASA), który występuje wyłącznie podczas aktywności seksualnej, zwiększając swoją intensywność wraz ze wzrostem podniecenia seksualnego lub pojawiając się nagle podczas orgazmu¹².

Patofizjologia bólów głowy podczas seksu

Dokładna patofizjologia bólów głowy związanych z aktywnością seksualną pozostaje nie w pełni poznana, jednak obecne badania wskazują na kilka potencjalnych mechanizmów¹²:

Komponenta naczyniowa

Jedną z głównych hipotez jest naczyniowe podłoże tych bólów głowy. Badania wskazują, że podczas aktywności seksualnej dochodzi do znacznego wzrostu ciśnienia tętniczego, które może zwiększyć się o 40-100 mmHg dla ciśnienia skurczowego i 20-50 mmHg dla ciśnienia rozkurczowego podczas orgazmu¹. Ten nagły wzrost ciśnienia prowadzi do szybkiego rozszerzenia naczyń krwionośnych w mózgu, co może wywołać ból u predysponowanych osób².

W badaniu przeprowadzonym przez Eversa i wsp. u pacjentów z eksplozywnym typem HAWSA wykorzystano test z acetazolamidem i przezczaszkowe badanie dopplerowskie. Wykazano, że pacjenci z HAWSA mieli znacznie większy wzrost ciśnienia tętniczego podczas standardowego wysiłku fizycznego w porównaniu z grupą kontrolną. Po podaniu 1 g acetazolamidu u pacjentów z HAWSA wystąpiło znacznie większe zwiększenie prędkości przepływu mózgowego oraz znacznie mniejsze zmniejszenie wskaźnika pulsacyjności w porównaniu z osobami zdrowymi i pacjentami z migreną. Sugeruje to, że u pacjentów z HAWSA dochodzi do uszkodzenia metabolicznego, a nie miogennego komponentu sprzężenia naczyniowo-neuronalnego w mózgu¹².

Zaburzenia autoregulacji naczyniowej

Kolejną istotną teorią jest upośledzenie autoregulacji naczyń mózgowych. Badania wykazały, że pacjenci z HAWSA mogą mieć zaburzoną zdolność do prawidłowej regulacji przepływu mózgowego w odpowiedzi na zmiany ciśnienia tętniczego¹. Ta nieprawidłowa autoregulacja może prowadzić do nadmiernego rozszerzenia naczyń mózgowych podczas aktywności seksualnej, co wywołuje ból².

Niektórzy badacze sugerują, że bóle głowy podczas seksu mogą mieć pochodzenie żylne. Według tej teorii, zwężenie żylne mogłoby powodować bezobjawowe zwiększenie ciśnienia śródczaszkowego u pacjentów, co sprzyja krótkotrwałym napadom zwiększonego ciśnienia płynu mózgowo-rdzeniowego i ciśnienia żylnego podczas manewru Valsalvy, wysiłku lub aktywności seksualnej, prowadząc do nagłego pojawienia się krótkotrwałych bólów głowy¹.

Komponenta mięśniowa

Ważnym czynnikiem w patogenezie HAWSA jest napięcie mięśni szyi, głowy i twarzy. Podczas aktywności seksualnej dochodzi do zwiększonego napięcia tych mięśni, co może przyczyniać się do pojawienia się bólu głowy¹. Ta teoria jest szczególnie istotna w przypadku bólów głowy typu napięciowego związanych z aktywnością seksualną, które narastają stopniowo wraz ze wzrostem podniecenia seksualnego².

Bóle przedorgazmiczne są prawdopodobnie związane z nadmiernym skurczem mięśni szyi i szczęki podczas aktywności seksualnej. Można ich uniknąć poprzez świadome rozluźnienie tych mięśni podczas stosunku¹.

Związek z układem współczulnym

Podczas aktywności seksualnej i orgazmu dochodzi do aktywacji układu współczulnego, co prowadzi do uwolnienia adrenaliny. Ten mechanizm może przyczyniać się do powstawania bólu głowy¹. Nadmierna aktywacja układu współczulnego wydaje się być istotnym czynnikiem współdziałającym w patogenezie bólów głowy związanych z aktywnością seksualną².

Teoria ta sugeruje, że podczas orgazmu dochodzi do gwałtownego wzrostu aktywności współczulnej, co prowadzi do zmian w przepływie krwi i ciśnieniu tętniczym, które mogą wywoływać ból głowy u predysponowanych osób¹.

Związek z innymi zespołami bólowymi

Badania wykazują, że HAWSA często współwystępuje z innymi pierwotnymi bólami głowy, takimi jak migrena, ból głowy typu napięciowego czy ból głowy wysiłkowy¹. Około 25-47% pacjentów z HAWSA cierpi również na migrenę².

Zaobserwowano również, że około 40% pacjentów z bólami głowy związanymi z aktywnością seksualną doświadcza również bólów głowy podczas wysiłku fizycznego niezwiązanego z aktywnością seksualną¹. Sugeruje to wspólne mechanizmy patofizjologiczne dla tych zespołów bólowych².

Patomechanizm łączący te różne typy bólów głowy może obejmować zwiększenie ciśnienia śródczaszkowego, niewłaściwą reakcję naczyń mózgowych na wysiłek oraz nadwrażliwość neuronalną, podobną do tej obserwowanej w migrenie¹.

prolaktyny-i-cgrp”>Rola prolaktyny i CGRP

Najnowsze badania zwracają uwagę na rolę prolaktyny i peptydu związanego z genem kalcytoniny (CGRP) w patogenezie bólów głowy. Prolaktyna jest neurohormonem, który selektywnie uwrażliwia nocyceptory u kobiet i zwiększa uwalnianie CGRP – neuropeptydu, który odgrywa kluczową rolę w powstawaniu migreny u wielu pacjentów¹².

Zarówno prolaktyna, jak i CGRP promują zachowania bólowe podobne do migreny, szczególnie u kobiet. Prolaktyna jest kontrolowana przez estrogen i stres, co może wyjaśniać zróżnicowanie płciowe w występowaniu niektórych typów bólów głowy¹.

Badania wykazały, że CGRP aplikowany bezpośrednio na oponę twardą wywoływał zachowania bólowe podobne do migreny przy znacznie niższych dawkach i z dłużej trwającymi efektami u samic myszy w porównaniu do samców. Selektywność płciowa CGRP w promowaniu bólu podobnego do migreny została potwierdzona przez bezpośrednią aplikację na oponę twardą u gryzoni¹.

Mechanizm działania w różnych typach bólu głowy związanego z aktywnością seksualną

Międzynarodowa Klasyfikacja Bólów Głowy (ICHD-3) wyróżnia dwa główne typy PHASA¹²:

Typ narastający (przedorgazmiczny)

Ten typ bólu głowy rozpoczyna się jako tępy ból w trakcie aktywności seksualnej, stopniowo nasilający się wraz ze wzrostem podniecenia seksualnego. Mechanizm tego typu bólu głowy prawdopodobnie wiąże się ze stopniowym wzrostem napięcia mięśni głowy i szyi oraz powolnym wzrostem ciśnienia tętniczego¹.

Charakterystyka kliniczna tego typu sugeruje związek z bólami głowy typu napięciowego/skurczem mięśni². Ból najczęściej zlokalizowany jest obustronnie, a jego intensywność stopniowo narasta wraz ze wzrostem podniecenia seksualnego¹.

Typ eksplozywny (orgazmiczny)

Ten typ bólu głowy pojawia się nagle, zwykle w momencie orgazmu lub tuż przed nim, i charakteryzuje się gwałtownym, intensywnym bólem, często opisywanym jako „najgorszy ból głowy w życiu”. Mechanizm tego typu bólu głowy związany jest z nagłym wzrostem ciśnienia tętniczego i rozszerzeniem naczyń mózgowych podczas orgazmu¹.

W przypadku bólów głowy typu 2, jako możliwy mechanizm zaproponowano zwiększone ciśnienie śródczaszkowe wtórnie do manewru Valsalvy podczas orgazmu². Ciśnienie krwi może wzrosnąć o 40-100 mmHg skurczowo i 20-50 mmHg rozkurczowo podczas orgazmu, co prowadzi do szybkiego rozszerzenia naczyń krwionośnych w mózgu i wywołania bólu¹.

Typ popozyskowy

Istnieje również trzeci, niezwykle rzadki typ bólu głowy związanego z aktywnością seksualną, występujący u około jednej na 20 000 osób. Ten rodzaj bólu pojawia się po stosunku i nasila się podczas wstawania. U osób doświadczających tego typu bólu często występuje cienka wyściółka mózgu, a wzrost ciśnienia krwi związany z aktywnością fizyczną podczas stosunku powoduje wyciek płynu mózgowo-rdzeniowego, co z kolei powoduje opadanie mózgu podczas stania¹.

Podobieństwa do innych zespołów bólu głowy

PHASA wykazuje pewne podobieństwa do innych pierwotnych zespołów bólu głowy, co sugeruje istnienie wspólnych mechanizmów patofizjologicznych¹:

Bóle głowy podczas kaszlu i wysiłku fizycznego mają pewne cechy wspólne z PHASA, chociaż dotyczą innych grup wiekowych i mają inne rozkłady płci¹
Badania sugerują, że PHASA i zespół odwracalnego skurczu naczyń mózgowych (RCVS) mogą należeć do tego samego spektrum chorobowego. Zatem patogeneza RCVS, taka jak dysfunkcja napięcia naczyń mózgowych i upośledzenie bariery krew-mózg, może również odgrywać kluczową rolę w pierwotnych bólach głowy związanych z aktywnością seksualną²
U niektórych pacjentów PHASA współwystępuje z półkolczystym bólem głowy (hemicrania continua), co sugeruje wspólną patofizjologię. Odpowiedź obu zaburzeń bólowych na indometacynę może wskazywać na wspólny patomechanizm¹

Mechanizm działania leków stosowanych w leczeniu PHASA

Mechanizm działania leków stosowanych w leczeniu PHASA opiera się na ich wpływie na patofizjologię tego schorzenia¹²:

Beta-blokery (propranolol, metoprolol) – zmniejszają aktywność układu współczulnego, co prowadzi do obniżenia ciśnienia tętniczego i częstości akcji serca, zapobiegając gwałtownym zmianom hemodynamicznym podczas aktywności seksualnej¹
Blokery kanału wapniowego (werapamil) – rozszerzają naczynia krwionośne i obniżają ciśnienie tętnicze, co może zapobiegać nadmiernemu rozszerzeniu naczyń mózgowych podczas orgazmu²
Indometacyna – niesteroidowy lek przeciwzapalny, który hamuje syntezę prostaglandyn, zmniejszając stan zapalny i rozszerzenie naczyń krwionośnych¹
Tryptany – działają jako agoniści receptorów serotoninowych, powodując zwężenie rozszerzonych naczyń krwionośnych w mózgu i hamując uwalnianie prozapalnych neuropeptydów²
Topiramat – wykazuje działanie przeciwpadaczkowe, prawdopodobnie poprzez blokowanie kanałów sodowych i wzmacnianie działania kwasu gamma-aminomasłowego (GABA), co może mieć wpływ na nadpobudliwość neuronalną¹

Czynniki ryzyka i patomechanizmy modulujące

Istnieje kilka czynników ryzyka i mechanizmów modulujących, które mogą wpływać na występowanie i nasilenie PHASA¹:

Płeć – bóle głowy związane z aktywnością seksualną występują 3-4 razy częściej u mężczyzn niż u kobiet¹
Wiek – PHASA może wystąpić w każdym wieku, ale najczęściej pojawia się po raz pierwszy u osób w wieku około 40 lat²
Predyspozycje genetyczne – osoby z migreną, bólami głowy wysiłkowymi lub kaszlowymi bólami głowy mają zwiększone ryzyko wystąpienia PHASA¹
Nadciśnienie tętnicze – osoby z nadciśnieniem tętniczym mogą być bardziej narażone na wystąpienie PHASA ze względu na większą reaktywność naczyń krwionośnych²
Stres i napięcie emocjonalne – zwiększone napięcie psychiczne i fizyczne może przyczyniać się do wystąpienia PHASA¹
Czynniki związane ze stylem życia – palenie tytoniu, spożywanie alkoholu i siedzący tryb życia mogą zwiększać ryzyko wystąpienia PHASA²

Mechanizmy łączące PHASA z innymi schorzeniami

PHASA może być powiązany z innymi schorzeniami poprzez wspólne mechanizmy patofizjologiczne¹:

Migrena – zarówno migrena, jak i PHASA mogą być związane z zaburzeniami regulacji naczyniowej i nadwrażliwością układu trójdzielno-naczyniowego¹
Zespół odwracalnego skurczu naczyń mózgowych (RCVS) – odwracalny segmentalny skurcz naczyń opisywano u pacjentów z piorunującym bólem głowy wywołanym wysiłkiem lub orgazmem²
Hiperinsulinemia – u niektórych pacjentów z półkolczystym bólem głowy i PHASA zaobserwowano hiperinsulinemię, co sugeruje potencjalne powiązanie metaboliczne¹
Nietolerancja wysiłku – pacjenci z PHASA mogą wykazywać zwiększoną reaktywność naczyniową na wysiłek fizyczny, co może być związane z zaburzeniami regulacji przepływu mózgowego²
Dysfunkcja układu serotoninergicznego – zaburzenia funkcji układu serotoninergicznego mogą odgrywać kluczową rolę zarówno w PHASA, jak i w innych pierwotnych bólach głowy¹

Mechanizmy ułatwiające lub ochronne

Interesującym aspektem jest obserwacja, że aktywność seksualna może zarówno wywoływać, jak i łagodzić bóle głowy, w zależności od typu bólu głowy i indywidualnych predyspozycji¹:

Około 60% osób z migreną zgłosiło poprawę swoich bólów głowy podczas aktywności seksualnej¹
Ponad jedna trzecia mężczyzn i prawie 14% kobiet z migreną regularnie wykorzystywało aktywność seksualną jako narzędzie terapeutyczne²
Niestety, około jedna trzecia osób z migreną stwierdziła, że ich bóle głowy nasilały się podczas aktywności seksualnej¹
Mechanizm łagodzenia bólu głowy przez aktywność seksualną może być związany z uwalnianiem endorfin, które są naturalnymi środkami przeciwbólowymi²
Inna teoria sugeruje, że aktywność seksualna może odwracać uwagę od bólu lub wpływać na uwalnianie neuroprzekaźników, takich jak serotonina i dopamina¹

Rozwój koncepcji i patomechanizm bólu głowy podczas seksu

Koncepcja bólu głowy związanego z aktywnością seksualną ewoluowała na przestrzeni lat¹. Początkowo w ICHD-I i ICHD-II wyróżniano dwa podtypy: ból głowy przedorgazmiczny i orgazmiczny. Jednak późniejsze badania kliniczne nie były w stanie rozróżnić tych dwóch typów, dlatego obecnie PHASA jest uznawany za pojedynczą jednostkę o zmiennej prezentacji².

Badania nad patofizjologią PHASA koncentrują się głównie na trzech komponentach¹²:

System trójdzielno-naczyniowy – utworzony przez neurony unerwiające oponę twardą i naczynia oponowe, których ciała neuronalne znajdują się w zwoju trójdzielnym¹
Odruch trójdzielno-autonomiczny – stymulacja zwoju skrzydłowo-podniebiennego powoduje objawy autonomiczne²
System podwzgórzowy – podwzgórze odgrywa rolę w procesie nocyceptywnym systemu trójdzielno-naczyniowego i otrzymuje projekcje z nerwu trójdzielnego poprzez trakt trójdzielno-podwzgórzowy¹

Interakcja tych trzech komponentów jest odpowiedzialna za charakterystyczną prezentację kliniczną różnych typów bólów głowy, w tym PHASA².

Diagnostyka różnicowa i znaczenie kliniczne

Chociaż większość bólów głowy związanych z aktywnością seksualną ma charakter łagodny, ważne jest, aby wykluczyć potencjalnie zagrażające życiu przyczyny wtórne, szczególnie przy pierwszym wystąpieniu¹. Bóle głowy związane z aktywnością seksualną, które pojawiają się nagle, są bardziej prawdopodobnie związane z²:

Poszerzeniem lub tętniakiem ściany tętnicy wewnątrz głowy (tętniak wewnątrzczaszkowy)
Nieprawidłowym połączeniem między tętnicami a żyłami w mózgu (malformacja tętniczo-żylna), które krwawi do przestrzeni wypełnionej płynem mózgowo-rdzeniowym w mózgu i wokół niego
Krwawieniem do ściany tętnicy prowadzącej do mózgu (rozwarstwienie)
Zwężeniem tętnic w mózgu (odwracalny zespół skurczu naczyń mózgowych)
Udarem mózgu
Chorobą wieńcową
Stosowaniem niektórych leków, takich jak tabletki antykoncepcyjne
Zapaleniem wynikającym z niektórych infekcji

Bóle głowy związane z aktywnością seksualną, którym towarzyszy utrata przytomności, wymioty, sztywność karku, inne objawy neurologiczne i silny ból trwający dłużej niż 24 godziny, są bardziej prawdopodobnie spowodowane chorobą podstawową¹.

Z tego powodu przy pierwszym wystąpieniu bólu głowy związanego z aktywnością seksualną zalecane jest wykonanie badań neuroobrazowych zarówno miąższu mózgu, jak i naczyń mózgowych, aby wykluczyć przyczyny wtórne. Przy pierwszym wystąpieniu należy wykluczyć krwotok podpajęczynówkowy. U osób z wieloma atakami bólu głowy związanego z aktywnością seksualną należy rozważyć zespół odwracalnego skurczu naczyń mózgowych, dopóki nie zostanie to wykluczone¹².

Przebieg naturalny i rokowanie

Przebieg naturalny PHASA jest zmienny¹. W badaniu 26 pacjentów bóle głowy ustąpiły u 50% po 6 tygodniach do 6 miesięcy, ale nawróciły u 50% po remisjach trwających do 6 lat².

Nowsze badania wykazały, że do 40% wszystkich przypadków ma przebieg przewlekły trwający ponad rok¹. Niektórzy pacjenci doświadczają tylko jednego ataku PHASA w życiu².

U większości pacjentów PHASA ma charakter łagodny i samoograniczający, ale może znacząco wpływać na jakość życia i funkcjonowanie seksualne. Właściwe rozpoznanie i leczenie może pomóc w zapobieganiu nawrotom i łagodzeniu objawów¹.

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Materiały źródłowe

#1 Primary headache associated with sexual activity (Orgasmic headache)
https://americanmigrainefoundation.org/resource-library/orgasmic-pre-orgasmic-headache/
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 âprimaryâ because itâs 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.
#1 Primary headache associated with sexual activity | MedLink Neurology
https://www.medlink.com/articles/primary-headache-associated-with-sexual-activity
Sexually related headache may be primary or secondary. In this article, the author updates the discussion of primary headache associated with sexual activity. This headache can start as a dull bilateral ache with increasing sexual excitement or suddenly become intense with orgasm. Neuroimaging studies of both brain parenchyma and cerebral vasculature are recommended for all patients to exclude secondary causes. On the first onset, subarachnoid hemorrhage must be ruled out. Reversible cerebral vasoconstriction syndrome should be considered until proven otherwise in those with multiple attacks of sexual headache. […] The pathophysiology of primary headaches associated with sexual activities remains unclear. A study of cerebral hemodynamics showed that patients with explosive type of sexual headache had both a higher increase of cerebral blood flow velocity and a lower decrease of the pulsatility index of the middle cerebral artery after acetazolamide test in comparison with healthy subjects. The data suggested an impairment of the metabolic rather than the myogenic component of the cerebral vaso-neuronal coupling.
#1 What if the âsexual headacheâ is not a joke? | British Journal of Medical Practitioners
https://www.bjmp.org/content/what-if-sexual-headache-not-joke
Headaches associated with sexual activity can be anything but a joke. HSA (headaches associated with sexual activity) are by definition benign conditions but the symptoms can be the same as in serious life threatening cerebral conditions and these need to be quickly excluded at the first presentation. HSA are capricious in nature with poorly understood pathophysiology and uncertain course of the condition. HSA are not clearly understood but by definition lack serious underlying disease. The clinical characteristics of Type 1 suggest a relationship with tension/muscular contraction headaches. There is a significant association between the risk of having more than one cluster of HSA and the presence of tension headaches or migraine. The prevalence of migraine in HSA patients is 25-47%. In type 2 headaches, increased intracranial pressure secondary to a Valsalva maneuver during orgasm has been proposed as a possible mechanism. Blood pressure may increase by 40-100mmHg systolic and 20-50mmHg diastolic during orgasm. A possible disruption of autoregulation of the cerebral vasculature has also been proposed.
#1 Headache Associated with Sexual ActivityâA Narrative Review of Literature
https://pmc.ncbi.nlm.nih.gov/articles/PMC8400207/
The etiopathogenesis of HAWSA is unknown. It was hypothesized that it is a form of vascular headache. The mechanism of action might be mainly due to trigeminal-vascular effect with a distinct muscular component. In addition, some factors such as hypertension, pre-existing migraine, and psychological features are thought to be important in the development of HAWSA. […] A number of determinants of HAWSA have been described. The majority of these are single case reports in which the authors search for an association between HAWSA and various etiologic factors; in many of these a clear cause-and-effect scenario can be identified, but there are also some in which the association is weak or questionable. […] In a study by Evers et al. 12 patients with the explosive type of HAWSA were studied during a headache-free state using an acetazolamide test and transcranial Doppler sonography. The control group consisted of 12 age-matched migraine patients and 14 healthy subjects. The authors assessed changes in blood pressure, cerebral blood flow velocity (CBFV), and pulsatility index (PI). Patients with HAWSA showed significantly higher increases of blood pressure during standard physical exercise compared to controls. Changes of CBFV under exercise did not differ among the three study groups. After administration of 1 g of acetazolamide, CBFV showed a significantly greater increase in patients with HAWSA than in healthy subjects, and PI showed a significantly smaller decrease compared with healthy subjects and migraine patients. The authors concluded that these data suggest that the metabolic rather than myogenic component of brain vasoneuronal coupling is damaged in patients with HAWSAs.
#1 Headache after Sex: Symptoms and Treatment | Doctor
https://patient.info/doctor/primary-sexual-headache
Primary sexual headache has been re-classified by the International Headache Society (IHS) as primary headache associated with sexual activity (PHASA). The exact prevalence in not known, although it is more common in men. […] Several theories have been put forth to explain the underlying mechanism of PHASA. The exact pathophysiology is unknown. However, a muscular component and impaired cerebrovascular autoregulation have been suggested. […] Headaches provoked by cough and exertion share some features with PHASA, although they affect different age groups and have different gender distributions. […] While most headaches relating to sexual activity are benign, a few are associated with significant morbidity (’malignant coital cephalgia’). […] Some patients have reversible cerebral vasoconstriction syndromes. […] These can be difficult to distinguish from PHASA. […] Subarachnoid bleeding may be precipitated by coitus in patients with berry aneurysms and arteriovenous malformations. […] Basilar artery dissection presenting as thunderclap headache with orgasm has been reported.
#1 Primary headache associated with sexual activity | MedLink Neurology
https://www.medlink.com/articles/primary-headache-associated-with-sexual-activity
Sharing similar clinical profiles, the cohort study suggested that primary headache associated with sexual activity and reversible cerebral vasoconstriction syndrome presented with sexual headache may be of the same disease spectrum. Therefore, the pathogenesis of reversible cerebral vasoconstriction syndrome such as dysfunction of cerebral vascular tone and impairment of blood-brain barrier may also play key roles in primary headache associated with sexual activities. […] One study has been hypothesized that benign headaches related to sexual activity may have a venous origin. This group speculates that venous stenosis could cause asymptomatic raised intracranial pressure in patients that promotes short-lasting paroxysms of increased CSF pressure and venous pressure with Valsalva exercises, exertion, or sexual activity, leading to abrupt onset of short-lasting headaches. However, the group failed to support this hypothesis with MR venography on their patient cohort.
#1 Orgasm Headaches: Why Do They Happen?
https://health.clevelandclinic.org/orgasm-headache
Sex-induced headaches are medically known as headaches associated with sexual activity (HAS). Theyre a type of exertion headache, which can happen with sudden or intense physical activity (think running, lifting weights or even sneezing). […] Neurologists know that many people get headaches during sex, but they dont have much info on the exact physiological cause. […] During sex, your heart rate and blood pressure can increase quite a lot, explains Dr. Galvez-Jimenez. Blood vessels in your brain dilate or open up. The muscles in your head, neck and shoulders tighten. […] All of these reactions can add up to headaches that, for some people, are very sudden and severe. […] Dr. Galvez-Jimenez adds that the most severe sex headaches seem to happen in people with chronic migraines or a history of migraines. People with migraines also seem to get more sex headaches than people who dont get migraines.
#1
https://healthmatch.io/migraine/orgasm-migraine
Headaches can be brought on by a number of causes, such as dehydration or stressful life events. Cardiovascular functioning also plays a major role in both sexual activity and headaches. In fact, all three of these factors are integral to orgasmic functioning, while a dysfunction with any one of them can lead to the onset of headaches. […] Orgasms involve extremely high levels of brain activity. Those with predispositions or sensitivities to headaches, even if they are not felt at any other time, could be experiencing the exacerbation of headache symptoms that normally remain under the threshold of awareness during the regular, non-orgasmic experience. […] Furthermore, pre-orgasmic headaches have been proposed to arise from excessive contraction of neck and jaw muscles during sexual activity. Thus, they may be avoided by conscious relaxation of these muscles during intercourse.
#1
https://www.menshealth.com/health/a19544397/sex-headache/
About half of people who suffer from them also get headaches while they exercise, says Dr. Reitano. That gives us a hint to a potential cause: The headaches may just result from the rise in blood pressure that happens with physical activity and yes, and as your rise in heart rate during sex shows, getting busy is considered a form of physical activity. […] What’s more, the adrenaline released during sex might also contribute by increasing pressure in your brain, says integrative medicine physician Bindiya Gandhi, M.D. Contraction of the neck muscles is sometimes a culprit as well. […] Certain over-the-counter drugs like Sudafed can also contribute to these headaches by causing restriction and over-dilation of blood vessels, says Dr. Reitano. There’s also anecdotal evidence of marijuana, red wine, cheese, and other foods contributing to them, though it’s not clear why. Smoking, drinking, and being sedentary or obese can increase your risk, too.
#1 Everything You Wanted to Know About Sex and Migraine (But Were Afraid to Ask!) – Association of Migraine Disorders
https://www.migrainedisorders.org/everything-you-wanted-to-know-about-sex-and-migraines-but-were-afraid-to-ask/
The current thought is that all three types of headache syndromes are related. […] Scientists are not entirely sure, but it is thought to be related to blood vessel changes, even when the ominous conditions have been ruled out. […] It is known that blood pressure quickly elevates around the time of orgasm, with intense exercise, and with coughing, and then blood vessels dilate. This could be what causes the pain. […] One thought is that valsalva (bearing down) causes vessel changes and rise in blood pressure. […] It appears that people who have any of the 3 headache syndromes (orgasm, exertion, cough) may have impaired auto-regulation of their blood flow due to their blood vessels dilating too much. […] Another theory is that when someone climaxes or is exercising vigorously, there is a surge of their sympathetic autonomic nervous system which causes a release of adrenaline (also known as epinephrine). This gets your heart rate pounding, similar to a âfight or flightâ response.
#1 Primary Headache Associated with Sexual Activity: A Review of the Literature – PubMed
https://pubmed.ncbi.nlm.nih.gov/38367200/
Purpose of review: This review summarizes the evolution in diagnosis, evaluation, and treatment of primary headache associated with sexual activity (PHASA). […] Recent findings: Despite increased access to patient information and advances in imaging, the pathophysiology of PHASA remains not fully understood. […] PHASA is commonly comorbid with migraine, tension-type headache, exertional headache, and hypertension. […] PHASA can present as a dull headache that progresses with sexual excitement, or an explosive headache at or around orgasm. […] Pain is primarily occipital, diffuse, and bilateral. […] The headaches are discrete, recurrent events with bouts that typically self-resolve, but may also relapse and remit or continue chronically in some patients. […] PHASA can be treated preemptively with indomethacin and triptans administered prior to sexual activity, or treated prophylactically with beta-blockers, topiramate, and calcium channel blockers. […] CGRP-targeted therapies may provide relief in PHASA based on a few case reports, but there are no randomized controlled trials looking at specific efficacy for these therapies.
#1 Sexual headache – Wikipedia
https://en.wikipedia.org/wiki/Sexual_headache
For some patients, the headaches may be related to general exertion. About 40% of patients with sexual headaches in one study also experienced headaches from non-sexual exertion. A pressor response to exercise has been suggested as a mechanism. For other patients, the pain appears to be specifically activated by sexual excitement and contraction of facial and neck muscles. […] Sudden, severe headaches during sexual activity may also be caused by intracerebral hemorrhage, subarachnoid hemorrhage, or cerebral infarction, which require immediate medical attention.
#1
https://link.springer.com/article/10.1007/s11940-002-0048-7
Several theories have been put forth to explain the underlying mechanism of exertional, cough, and sexual headache. The leading explanation regarding all three involves exertional factors leading to a sudden increase in intracranial pressure or an inappropriate reaction in the cerebral vasculature. […] Because exertion may also be a migraine trigger, neural hypersensitivity, similar to migraine, may also play a role in HAPEF.
#1 Female-selective mechanisms promoting migraine | The Journal of Headache and Pain | Full Text
https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-024-01771-w
Sexual dimorphism has been revealed for many neurological disorders including chronic pain. […] Migraine is a common female-prevalent neurological disorder that is characterized by painful and debilitating headache. Prolactin is a neurohormone that circulates at higher levels in females and that has been implicated clinically in migraine. Prolactin sensitizes sensory neurons from female mice, non-human primates and humans revealing a female-selective pain mechanism that is conserved evolutionarily and likely translationally relevant. Prolactin produces female-selective migraine-like pain behaviors in rodents and enhances the release of calcitonin gene-related peptide (CGRP), a neurotransmitter that is causal in promoting migraine in many patients. […] Consistent with these observations, publicly available clinical data indicate that small molecule CGRP-receptor antagonists are preferentially effective in treatment of acute migraine therapy in women. Collectively, these observations support the conclusion of qualitative sex differences promoting migraine pain providing the opportunity to tailor therapies based on patient sex for improved outcomes.
#1 Female-selective mechanisms promoting migraine | The Journal of Headache and Pain | Full Text
https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-024-01771-w
Significantly, this female predominant hormone enhances CGRP release. […] Prolactin is under control of estrogen as well as stress. […] Prolactin is released from pituitary lactotrophs and is under tight inhibitory control by hypothalamic dopaminergic tuberoinfundibular (TIDA) cells. […] In humans, stress increases circulating prolactin, lowers sensory thresholds increasing the likelihood of pain attacks, is associated with painful menstruation (i.e., dysmenorrhea) and importantly, is the most common self-identified migraine trigger. […] Preclinical studies show that the TIDA cells are inhibited by stress-related transmitters resulting in increased circulating prolactin. […] Importantly, application of CGRP directly to the dura mater elicited both evoked and ongoing migraine-like pain behaviors at much lower doses and with longer lasting effects in female, compared to male mice.
#1 Female-selective mechanisms promoting migraine | The Journal of Headache and Pain | Full Text
https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-024-01771-w
Preclinical studies have also consistently demonstrated that prolactin is selective in sensitizing female nociceptors and associated with increased release of CGRP. […] These studies reveal cross-talk between prolactin and CGRP that is relevant to migraine-like pain in females. […] The female selectivity of CGRP might thus be influenced by sexual dimorphism in the expression of either CLR and/or RAMP1. […] The female selectivity of PRL in promoting migraine-like pain behavior was confirmed by direct dural application in rodents. […] Collectively, these studies support the conclusion that there are male and female nociceptors that can be distinguished at the transcript, protein and functional levels. […] The female selectivity of CGRP in promoting migraine-like pain and the apparent female selective effects of CGRP-R antagonists support the possibility that fundamental biological differences exist between men and women in mechanisms of migraine, and other, pain conditions.
#1 4.3 Primary headache associated with sexual activity – ICHD-3
https://ichd-3.org/other-primary-headache-disorders/4-3-primary-headache-associated-with-sexual-activity/
4.3 Primary headache associated with sexual activity […] Previously used terms: Benign sex headache; benign vascular sexual headache; coital cephalalgia; coital headache; intercourse headache; orgasmic cephalalgia; orgasmic headache; sexual headache. […] Description: Headache precipitated by sexual activity, usually starting as a dull bilateral ache as sexual excitement increases and suddenly becoming intense at orgasm, in the absence of any intracranial disorder. […] Diagnostic criteria: […] 1. At least two episodes of pain in the head and/or neck fulfilling criteria B-D […] 2. Brought on by and occurring only during sexual activity […] 3. Either or both of the following: […] – increasing in intensity with increasing sexual excitement […] – abrupt explosive intensity just before or with orgasm
#1 Does Sex Ease Migraine Attacks or Trigger Them?
https://www.everydayhealth.com/pain-management/headache/sex-cure-or-trigger-for-migraine.aspx
Headaches during sex are most often seen in people with migraine because these people have a genetic predisposition to develop headaches already. […] In this sense, sex may be a migraine trigger like any other something that puts your brain out of its ordinary state, leading to migraine symptoms, especially when other migraine triggers are at play in a given person. […] When sex or an orgasm directly causes a headache, thats known as a sex headache. A sex headache can develop in someone with or without migraine, and can be brought on by any type of sexual activity. […] According to Dr. Green, sex can cause at least two different types of headaches that are distinct from a migraine attack an explosive headache or a tension headache. In a person with migraine, though, both of these headache types can lead to a migraine attack.
#1 Orgasm Headache: Causes, Treatment, and More
https://www.healthline.com/health/healthy-sex/orgasm-headache
Orgasm headaches are typically benign. But some additional symptoms may indicate a more severe condition. […] What you may have experienced is known as an orgasm headache, a rare but often harmless type of sex headache that happens before or at the moment of sexual release. […] A sexual benign headache happens because the increase in sexual excitement causes the muscles to contract in your head and neck, resulting in head pain. A orgasm headache, on the other hand, occurs because of a spike in blood pressure that causes your blood vessels to dilate. […] Treating your orgasm headache will depend on the cause. Sex headaches usually aren’t associated with an underlying condition, so taking a pain reliever should be enough to ease symptoms. […] In some cases, head pain during orgasm may indicate a serious issue.
#1 Orgasm headache: What do they feel like and what causes them?
https://www.medicalnewstoday.com/articles/324719
An orgasm headache is a sudden, intense headache before or during an orgasm. It is also called a primary headache associated with sexual activity. The exact cause is unclear, but some medications may help. […] Doctors do not know what causes orgasm headaches, but they may be a type of vascular headache. These result from blood vessels swelling in the brain. […] When a person has an orgasm, their blood pressure increases rapidly. This surge in pressure causes blood vessels in the head to dilate quickly, which can trigger sudden, intense headaches in some people. […] Orgasm headaches may result from a rapid expansion of blood vessels in the brain. This occurs when a person’s blood pressure rises before and during orgasms.
#1
https://www.menshealth.com/health/a19544397/sex-headache/
Theres also a third type of sex headache thats extremely rare, affecting only around one in every 20,000 people, according to Dr. Reitano. This kind starts after sex and gets worse when you stand up, and it can be all over the place on the pain scale. People who experience this often have thin brain lining, and the rise in blood pressure that comes from the physical activity of sex causes spinal fluid to leak, which in turn causes the brain to droop when you stand. […] To prevent chronic headaches, you may need to get the leak surgically sealed, says Dr. Reitano. You should talk to your doctor if you get headaches during sex not only to get treatment but also because in some rare cases, they could point toward issues like bleeding in the brain, artery swelling, or blood clots, says Dr. Reitano.
#1 Headache Associated with Sexual ActivityâA Narrative Review of Literature
https://pmc.ncbi.nlm.nih.gov/articles/PMC8400207/
The exact pathophysiologic relationship between headache and sexual activity is still debated. HAWSA may be accompanied by other complaints, such as migraine, hypnic headache or hemicrania continua. There may be a common pathophysiological mechanism for these complaints, but this has not been identified to date.
#1
https://journals.lww.com/neur/fulltext/2010/58040/hyper_insulinemia_in_an_hemicrania_continua.32.aspx
The coexistence of hemicrania continua with another primary headache disorder is a very rare event. […] A diagnosis of hemicrania continua (HC) and headache associated with sexual activity (HSA) (pre orgasmic headache) was made. […] Response of both headache disorders to indomethacin may suggest a common pathophysiology. […] Evers et al. demonstrated impaired cerebrovascular autoregulation in patients with HSA and suggested a possibility of stretching of small intracranial arteries to induce the activation of pain- processing trigemino- vascular system. […] Activation of the hypothalamus has been observed in patients with HC. In the same way, activation of the hypothalamus has been demonstrated during sexual activity and orgasm. […] The presence of hyper insulinemia in our patient is largely unexplained. However, impaired insulin sensitivity has been demonstrated in patients with migraine. […] Therefore, a similar type of association is possible in patients with HC.
#1 Sex headaches | Altru Health System
https://www.altru.org/health-library/conditions/sex-headaches
Sex headaches associated with loss of consciousness, vomiting, stiff neck, other neurological symptoms and severe pain lasting more than 24 hours are more likely to be due to an underlying cause. […] If you have a history of sex headaches and there’s no underlying cause, your doctor may recommend that you take preventive medications regularly. […] Daily medications. Beta blockers, for example, propranolol (Inderal, Innopran XL) or metoprolol (Lopressor, Toprol-XL) which are used to treat high blood pressure, coronary artery disease and migraines may be taken daily to prevent sex headaches. […] A calcium channel blocker, such as verapamil hydrochloride (Calan SR) which is also used to treat high blood pressure may be an option. […] In people who have a history of migraine, other migraine preventive medications may be used. […] Indomethacin, an anti-inflammatory, or one of the triptans, a class of anti-migraine medications, can be taken an hour before sex to prevent headaches.
#1
https://www.nbcnews.com/id/wbna48045734
Brain imaging on both teens revealed no abnormalities. Gelfand said the brain scans are performed to rule out any secondary cause of the headaches, such as an aneurysm that could be life-threatening. […] The headaches generally go away after several months, with some lasting a year, Gelfand said. In the meantime, they can be prevented with a medicine called indomethacin that’s analogous to ibuprofen, but keeps these sex headaches at bay if taken 30 minutes before sexual activity, Gelfand said.
#1 Headache Associated with Sexual ActivityâA Narrative Review of Literature
https://pmc.ncbi.nlm.nih.gov/articles/PMC8400207/
Headache associated with sexual activity (HAWSA) has accompanied humanity since ancient times. However, it is only since the 1970s that it has become the subject of more extensive and detailed scientific interest. The purpose of this review is to provide an overview of the development of the concept of HAWSA, its clinical presentation, etiopathogenesis, diagnosis and treatment especially from the research perspective of the last 20 years. Primary HAWSA is a benign condition, whose etiology is unknown; however, at the first occurrence of headache associated with sexual activity, it is necessary to exclude conditions that are usually immediately life-threatening. Migraine, hypnic headache or hemicrania continua have been reported to co-occur with HAWSA, but their common pathophysiologic basis is still unknown. Recent advances in the treatment of HAWSA include the introduction of topiramate, progesterone, and treatments such as greater occipital nerve injection, arterial embolization, and manual therapy. Whether these new therapeutic options will stand the test of time remains to be seen.
#1 Sex headaches – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/sex-headaches/symptoms-causes/syc-20377477
In rare instances, headaches can be brought on by sexual activity especially with orgasm. […] Most sex headaches are nothing to worry about. But some can be a sign of something serious, such as problems with the blood vessels that feed the brain. […] Any type of sexual activity that leads to orgasm can trigger sex headaches. […] Abrupt-onset and slow-to-build sex headaches can be primary headache disorders not associated with any underlying condition. Sex headaches that come on suddenly are more likely to be associated with: […] Sex headaches associated with loss of consciousness, vomiting, stiff neck, other neurological symptoms and severe pain lasting more than 24 hours are more likely to be due to an underlying cause. […] Sex headaches can affect anyone. But risk factors for these headaches include: […] Sometimes sex headaches can be prevented by stopping sexual activity before orgasm. Taking a more passive role during sex also may help.
#1 Headaches Associated With Sex Are No Joke
https://www.neurologylive.com/view/headaches-associated-sex-are-no-joke
The ICHD-3 also notes that these headaches can last from 1 minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity, and often cannot be better accounted for by another ICHD-3 diagnosis. […] The following are the 3 main types of sex-related headaches: A dull ache in the head and neck that begins before orgasm and gets worse as sexual arousal increases. It is similar to a tension headache. […] An intensely painful headache that begins during orgasm and can last for hours. This so-called thunderclap headache grabs attention because it comes on like a clap of thunder. […] A headache that occurs after sex and can range from mild to extremely painful. This headache gets worse when the patient stands and lessens when the patient lies back down. The cause is an internal leak of spinal fluid, which extends down from the skull into the spine. […] Biller said men are 3 to 4 times more likely to get headaches associated with sexual activity than women. Depending on the type of headache, medications can help relieve the pain or even prevent the headache, he said.
#1 Everything You Wanted to Know About Sex and Migraine (But Were Afraid to Ask!) – Association of Migraine Disorders
https://www.migrainedisorders.org/everything-you-wanted-to-know-about-sex-and-migraines-but-were-afraid-to-ask/
Whether you have migraine or not, some people experience a rare headache disorder called Sex Headache. […] The formal name of this condition is Headache Associated with Sexual activity. […] In two-thirds of people who experience sex headache the pain occurs on both sides of the head rather than one side of the head. […] In 80% of people, the pain is either widespread or located on the back of the head (occipital region). […] It usually lacks migraine features and is described as very intense pressure, the feeling as if oneâs head might explode. […] According to a paper published in 2010, Sex Headache occurs four times more often in men, and they are usually in their 40s when it first happens. […] People with a history of migraine, exertional headaches, or cough headaches may be more likely to get orgasm headaches.
#1 Sexual Headaches! Not a Joke – Dr. Emel GÃ¶kmen
https://www.emelgokmen.com/en/sexual-headache/
There is more people suffering from this condition than one can think about. But most of them is just having benign sexual headaches. […] Most sexual headache sufferers are the ones having a migraine and tension type headache history. Orgasmic headache is more likely to occur during stressful periods that trigger those headaches. […] Sexual headaches are common and affect life negatively. Thus, they need to be treated.
#1 A Case of Sex Headache and Vasospasmlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/jn200408060000008/2004/08/06/case-sex-headache-and-vasospasm
Thunderclap headache (TCH) refers to a severe headache of sudden onset in which pain reaches maximal intensity within seconds or minutes (J Neurol Neurosurg Psychiatry 2002; 72:11). […] Based on this case and a review of five similar cases in the literature, the authors postulate that vasospasm is involved in the pain mechanism and that sexual arousal and activation of autonomic reflexes are necessary to trigger the pain and vasospasm. […] However, reversible segmental vasospasm has been described in patients with spontaneous TCH or TCH triggered by exertion or orgasm. […] It is unlikely that the pathogenesis of the headache and the vasospasm is significantly different in those with spontaneous TCH versus those with a trigger. […] Therefore, close clinical observation of these patients is warranted.
#1 Primary Headache Associated with Sexual Activity Presenting with Persistent Genital Arousal Disorder: A Case Report
https://e-hpr.org/journal/view.php?number=902
Furthermore, some authors have suggested that negative appraisals of genital arousal may also lead to increased sympathetic nervous system activity in patients PGAD. […] While many aspects of PHASA’s pathophysiology and disease nature remain unclear, the fact that it is triggered during sexual activity suggests that an increased sympathetic tone would play a critical role in the generation of headaches. […] Second, serotonergic dysfunction could be a key component in both PGAD and PHASA.
#1 Does Sex Ease Migraine Attacks or Trigger Them?
https://www.everydayhealth.com/pain-management/headache/sex-cure-or-trigger-for-migraine.aspx
It can do both. But whether its a trigger or a remedy can depend on many factors. Research backs up this assertion: One study found that 60 percent of people who had sex during a migraine attack experienced some improvement in their headache symptoms. Another 33 percent, though, reported worse symptoms when they had sex during a migraine attack. […] In fact, for some people, sex may even trigger a migraine attack or another form of headache. […] One theory for why sexual activity can help during a migraine attack is that sex may distract people from their pain. Another is that sex in particular, an orgasm releases endorphins, which can also help relieve pain. […] But some people arent as lucky. Like exercise, sex is a physical activity that can put pressure on a persons back and neck, potentially bringing on a migraine attack. Plus, sex can increase blood pressure and cause dilation (widening) of blood vessels in the brain, which can also trigger an attack.
#1 Everything You Wanted to Know About Sex and Migraine (But Were Afraid to Ask!) – Association of Migraine Disorders
https://www.migrainedisorders.org/everything-you-wanted-to-know-about-sex-and-migraines-but-were-afraid-to-ask/
Around 60% of people with migraine reported an improvement of their headaches with sexual activity. […] Of the people with migraine who found improvement in their headaches with sexual activity, over one-third of the males and almost 14% of the females used sexual activity as a regular therapeutic tool. […] About 43% of people with migraine found that their headache changed shortly after orgasm or maximal excitement, almost 18% reported the change with the time of orgasm, 20% found the change at the beginning of sexual activity while another 20% had the change within 30 minutes of orgasm or maximal excitement. This change did not depend on type of sexual activity, partner, time of the migraine attack or position during sex. […] Unfortunately, about one-third of people with migraine who answered the survey found their headaches worsened with sexual activity.
#1 Migraine Episodes and Orgasms: What to Know
https://www.bezzymigraine.com/discover/real-talk-mig/health-orgasms-help-migraine-episodes/
Research into how exactly orgasms can help migraine is ongoing, but the medical community has a few theories. […] One theory is related to pain regulation and endorphins. […] One way to release endorphins: sex and orgasms. […] Other research indicates a possible connection with neurotransmitters, the chemical messengers that carry signals between cells in your body. […] According to the Association of Migraine Disorders, levels of certain neurotransmitters, including dopamine and serotonin, may be lower during migraine attacks. […] More specifically, sex and orgasms trigger the release of the neurotransmitters dopamine and serotonin. […] For some people, the opposite can be true. […] Sex and orgasms can actually trigger headache attacks or worsen migraine symptoms. […] Clinically speaking, sex-induced headaches are called headaches associated with sexual activity.
#1 Frontiers | Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment
https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1373528/full
Cluster headache (CH) is a primary headache belonging to the trigeminal autonomic cephalalgias (TAC) group. […] The pathophysiology of CH still needs to be understood. The current understanding is based on preclinical, clinical, and imaging studies in patients with the disease. […] The neuroanatomical and functional systems involved in the pathophysiology of CH can be divided into three principal components: (1) the trigeminovascular system, (2) the trigeminal-autonomic reflex (sphenopalatine ganglion stimulation), and (3) the hypothalamic system. […] The interaction of these three components is responsible for the characteristic clinical presentation of CH. […] The trigeminovascular system is formed by neurons innervating the dura mater and meningeal vessels, whose neuronal body is in the trigeminal ganglion.
#1 Frontiers | Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment
https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1373528/full
CH attacks involve activation of parasympathetic outflow, which causes typical trigeminal-autonomic symptoms such as lacrimation, conjunctival injection, and nasal congestion. […] The hypothalamus also plays a role in the nociceptive process of the trigeminovascular system and receives projections from the trigeminal nerve via the trigeminal-hypothalamic tract. […] The mechanistic relevance of the hypothalamus in CH is supported by circannual patterns, attack phenotypes, and accompanying neuroendocrine hormonal alterations, as well as by several neuroimaging studies that revealed an activation of the posterior hypothalamic region during attacks of CH. […] The activation of the trigeminal-autonomic reflex may be secondary to an activation of the trigeminovascular system; however, peripheral activation of afferent and efferent trigeminal-autonomic reflex branches is insufficient to generate CH attacks. […] The hypothalamus likely plays a central role in the pathophysiology, particularly in creating a brain state in which attacks are made possible.
#1 Ask the Experts – Etiology of Coital Headaches
https://www.medscape.com/viewarticle/413710
The natural history of the benign explosive type of sexual headaches is variable. In a study of 26 patients, the headaches went away in 50% after 6 weeks to 6 months but recurred in 50% after remissions of up to 6 years. Headaches may be prevented in some patients by weight loss, an exercise program, a more passive role during intercourse, variation in posture, limitation of additional sexual activity on the same day, and medications. Indomethacin, ergotamine tartrate, methylsergide, or naratriptan taken before sexual activity have been reported as preventive. Propranolol (40-200 mg total per day) and diltiazem (60 mg 3 times daily) can be given as a daily preventive if this headache type occurs frequently.
#1 4.3 Primary headache associated with sexual activity – ICHD-3
https://ichd-3.org/other-primary-headache-disorders/4-3-primary-headache-associated-with-sexual-activity/
Comments: Two subtypes (preorgasmic headache and orgasmic headache) were included in ICHD-I and ICHD-II, but clinical studies have since been unable to distinguish these; therefore, 4.3 Primary headache associated with sexual activity is now regarded as a single entity with variable presentation. […] Recent studies have shown that up to 40% of all cases run a chronic course over more than a year. […] Some patients experience only one attack of 4.3 Primary headache associated with sexual activity during their lives; they should be diagnosed as 4.3.1 Probable primary headache associated with sexual activity. For further research on this headache type, it is recommended to include only patients with at least two attacks. […] Epidemiological research has further shown that 4.3 Primary headache associated with sexual activity can occur at any sexually active age, is more prevalent in males than in females (ratios range from 1.2:1 to 3:1), occurs independently of the type of sexual activity, is not accompanied by autonomic or vegetative symptoms in most cases, is bilateral in two-thirds and unilateral in one-third of cases and is diffuse or occipitally localized in 80% of cases. Attack frequency of 4.3 Primary headache associated with sexual activity should always be related to the frequency of sexual activity.
#2 4.3 Primary headache associated with sexual activity – ICHD-3
https://ichd-3.org/other-primary-headache-disorders/4-3-primary-headache-associated-with-sexual-activity/
4.3 Primary headache associated with sexual activity […] Previously used terms: Benign sex headache; benign vascular sexual headache; coital cephalalgia; coital headache; intercourse headache; orgasmic cephalalgia; orgasmic headache; sexual headache. […] Description: Headache precipitated by sexual activity, usually starting as a dull bilateral ache as sexual excitement increases and suddenly becoming intense at orgasm, in the absence of any intracranial disorder. […] Diagnostic criteria: […] 1. At least two episodes of pain in the head and/or neck fulfilling criteria B-D […] 2. Brought on by and occurring only during sexual activity […] 3. Either or both of the following: […] – increasing in intensity with increasing sexual excitement […] – abrupt explosive intensity just before or with orgasm
#2 Headache Associated with Sexual ActivityâA Narrative Review of Literature
https://pmc.ncbi.nlm.nih.gov/articles/PMC8400207/
The etiopathogenesis of HAWSA is unknown. It was hypothesized that it is a form of vascular headache. The mechanism of action might be mainly due to trigeminal-vascular effect with a distinct muscular component. In addition, some factors such as hypertension, pre-existing migraine, and psychological features are thought to be important in the development of HAWSA. […] A number of determinants of HAWSA have been described. The majority of these are single case reports in which the authors search for an association between HAWSA and various etiologic factors; in many of these a clear cause-and-effect scenario can be identified, but there are also some in which the association is weak or questionable. […] In a study by Evers et al. 12 patients with the explosive type of HAWSA were studied during a headache-free state using an acetazolamide test and transcranial Doppler sonography. The control group consisted of 12 age-matched migraine patients and 14 healthy subjects. The authors assessed changes in blood pressure, cerebral blood flow velocity (CBFV), and pulsatility index (PI). Patients with HAWSA showed significantly higher increases of blood pressure during standard physical exercise compared to controls. Changes of CBFV under exercise did not differ among the three study groups. After administration of 1 g of acetazolamide, CBFV showed a significantly greater increase in patients with HAWSA than in healthy subjects, and PI showed a significantly smaller decrease compared with healthy subjects and migraine patients. The authors concluded that these data suggest that the metabolic rather than myogenic component of brain vasoneuronal coupling is damaged in patients with HAWSAs.
#2 Orgasm headache: What do they feel like and what causes them?
https://www.medicalnewstoday.com/articles/324719
An orgasm headache is a sudden, intense headache before or during an orgasm. It is also called a primary headache associated with sexual activity. The exact cause is unclear, but some medications may help. […] Doctors do not know what causes orgasm headaches, but they may be a type of vascular headache. These result from blood vessels swelling in the brain. […] When a person has an orgasm, their blood pressure increases rapidly. This surge in pressure causes blood vessels in the head to dilate quickly, which can trigger sudden, intense headaches in some people. […] Orgasm headaches may result from a rapid expansion of blood vessels in the brain. This occurs when a person’s blood pressure rises before and during orgasms.
#2 Primary headache associated with sexual activity | MedLink Neurology
https://www.medlink.com/articles/primary-headache-associated-with-sexual-activity
Sexually related headache may be primary or secondary. In this article, the author updates the discussion of primary headache associated with sexual activity. This headache can start as a dull bilateral ache with increasing sexual excitement or suddenly become intense with orgasm. Neuroimaging studies of both brain parenchyma and cerebral vasculature are recommended for all patients to exclude secondary causes. On the first onset, subarachnoid hemorrhage must be ruled out. Reversible cerebral vasoconstriction syndrome should be considered until proven otherwise in those with multiple attacks of sexual headache. […] The pathophysiology of primary headaches associated with sexual activities remains unclear. A study of cerebral hemodynamics showed that patients with explosive type of sexual headache had both a higher increase of cerebral blood flow velocity and a lower decrease of the pulsatility index of the middle cerebral artery after acetazolamide test in comparison with healthy subjects. The data suggested an impairment of the metabolic rather than the myogenic component of the cerebral vaso-neuronal coupling.
#2 Everything You Wanted to Know About Sex and Migraine (But Were Afraid to Ask!) – Association of Migraine Disorders
https://www.migrainedisorders.org/everything-you-wanted-to-know-about-sex-and-migraines-but-were-afraid-to-ask/
The current thought is that all three types of headache syndromes are related. […] Scientists are not entirely sure, but it is thought to be related to blood vessel changes, even when the ominous conditions have been ruled out. […] It is known that blood pressure quickly elevates around the time of orgasm, with intense exercise, and with coughing, and then blood vessels dilate. This could be what causes the pain. […] One thought is that valsalva (bearing down) causes vessel changes and rise in blood pressure. […] It appears that people who have any of the 3 headache syndromes (orgasm, exertion, cough) may have impaired auto-regulation of their blood flow due to their blood vessels dilating too much. […] Another theory is that when someone climaxes or is exercising vigorously, there is a surge of their sympathetic autonomic nervous system which causes a release of adrenaline (also known as epinephrine). This gets your heart rate pounding, similar to a âfight or flightâ response.
#2 Does Sex Ease Migraine Attacks or Trigger Them?
https://www.everydayhealth.com/pain-management/headache/sex-cure-or-trigger-for-migraine.aspx
Headaches during sex are most often seen in people with migraine because these people have a genetic predisposition to develop headaches already. […] In this sense, sex may be a migraine trigger like any other something that puts your brain out of its ordinary state, leading to migraine symptoms, especially when other migraine triggers are at play in a given person. […] When sex or an orgasm directly causes a headache, thats known as a sex headache. A sex headache can develop in someone with or without migraine, and can be brought on by any type of sexual activity. […] According to Dr. Green, sex can cause at least two different types of headaches that are distinct from a migraine attack an explosive headache or a tension headache. In a person with migraine, though, both of these headache types can lead to a migraine attack.
#2 Primary Headache Associated with Sexual Activity Presenting with Persistent Genital Arousal Disorder: A Case Report
https://e-hpr.org/journal/view.php?number=902
Persistent genital arousal disorder (PGAD) is characterized by unwanted and distressing genital sensations that are not associated with concomitant sexual interest or thoughts. […] The pathophysiology of PGAD remains largely unknown, but both psychiatric and medical aspects seem to be involved. […] PHASA is characterized as a headache occurring only during sexual activity, increasing in intensity with increasing sexual excitement, and peaking abruptly just before or during orgasm. […] Pathophysiologically, it is thought that the headache arises from vessels innervated by the trigeminal nerve, which is caused by vaso-neuronal coupling damage. […] We propose two mechanisms linking PGAD with PHASA in this case. First, sympathetic overactivation seems to be a significant contributing factor in both disorders.
#2 What if the âsexual headacheâ is not a joke? | British Journal of Medical Practitioners
https://www.bjmp.org/content/what-if-sexual-headache-not-joke
Headaches associated with sexual activity can be anything but a joke. HSA (headaches associated with sexual activity) are by definition benign conditions but the symptoms can be the same as in serious life threatening cerebral conditions and these need to be quickly excluded at the first presentation. HSA are capricious in nature with poorly understood pathophysiology and uncertain course of the condition. HSA are not clearly understood but by definition lack serious underlying disease. The clinical characteristics of Type 1 suggest a relationship with tension/muscular contraction headaches. There is a significant association between the risk of having more than one cluster of HSA and the presence of tension headaches or migraine. The prevalence of migraine in HSA patients is 25-47%. In type 2 headaches, increased intracranial pressure secondary to a Valsalva maneuver during orgasm has been proposed as a possible mechanism. Blood pressure may increase by 40-100mmHg systolic and 20-50mmHg diastolic during orgasm. A possible disruption of autoregulation of the cerebral vasculature has also been proposed.
#2
https://link.springer.com/article/10.1007/s11940-002-0048-7
Several theories have been put forth to explain the underlying mechanism of exertional, cough, and sexual headache. The leading explanation regarding all three involves exertional factors leading to a sudden increase in intracranial pressure or an inappropriate reaction in the cerebral vasculature. […] Because exertion may also be a migraine trigger, neural hypersensitivity, similar to migraine, may also play a role in HAPEF.
#2 Female-selective mechanisms promoting migraine | The Journal of Headache and Pain | Full Text
https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-024-01771-w
Prolactin is a neurohormone that selectively sensitizes nociceptors from female animals or from female post-mortem human donors. Prolactin increases release of calcitonin gene-related peptide (CGRP), a neuropeptide that is causal in many people with migraine. Both prolactin and CGRP promote migraine-like pain behaviors selectively in female animals. […] Sexual dimorphism therefore suggests that the uniform therapeutic approach for acute treatment of migraine, and pain-related disorders more generally, in men and women requires reassessment, and that opportunities exist for precision medicine based on patient sex. […] Recent work has also highlighted the role of prolactin, a circulating neurohormone that is released by the pituitary and that can also be produced locally by multiple cell types, in promoting migraine-like pain.
#2 4.3 Primary headache associated with sexual activity – ICHD-3
https://ichd-3.org/other-primary-headache-disorders/4-3-primary-headache-associated-with-sexual-activity/
Comments: Two subtypes (preorgasmic headache and orgasmic headache) were included in ICHD-I and ICHD-II, but clinical studies have since been unable to distinguish these; therefore, 4.3 Primary headache associated with sexual activity is now regarded as a single entity with variable presentation. […] Recent studies have shown that up to 40% of all cases run a chronic course over more than a year. […] Some patients experience only one attack of 4.3 Primary headache associated with sexual activity during their lives; they should be diagnosed as 4.3.1 Probable primary headache associated with sexual activity. For further research on this headache type, it is recommended to include only patients with at least two attacks. […] Epidemiological research has further shown that 4.3 Primary headache associated with sexual activity can occur at any sexually active age, is more prevalent in males than in females (ratios range from 1.2:1 to 3:1), occurs independently of the type of sexual activity, is not accompanied by autonomic or vegetative symptoms in most cases, is bilateral in two-thirds and unilateral in one-third of cases and is diffuse or occipitally localized in 80% of cases. Attack frequency of 4.3 Primary headache associated with sexual activity should always be related to the frequency of sexual activity.
#2 Primary headache associated with sexual activity | MedLink Neurology
https://www.medlink.com/articles/primary-headache-associated-with-sexual-activity
Sharing similar clinical profiles, the cohort study suggested that primary headache associated with sexual activity and reversible cerebral vasoconstriction syndrome presented with sexual headache may be of the same disease spectrum. Therefore, the pathogenesis of reversible cerebral vasoconstriction syndrome such as dysfunction of cerebral vascular tone and impairment of blood-brain barrier may also play key roles in primary headache associated with sexual activities. […] One study has been hypothesized that benign headaches related to sexual activity may have a venous origin. This group speculates that venous stenosis could cause asymptomatic raised intracranial pressure in patients that promotes short-lasting paroxysms of increased CSF pressure and venous pressure with Valsalva exercises, exertion, or sexual activity, leading to abrupt onset of short-lasting headaches. However, the group failed to support this hypothesis with MR venography on their patient cohort.
#2 Sex headaches | Altru Health System
https://www.altru.org/health-library/conditions/sex-headaches
Sex headaches associated with loss of consciousness, vomiting, stiff neck, other neurological symptoms and severe pain lasting more than 24 hours are more likely to be due to an underlying cause. […] If you have a history of sex headaches and there’s no underlying cause, your doctor may recommend that you take preventive medications regularly. […] Daily medications. Beta blockers, for example, propranolol (Inderal, Innopran XL) or metoprolol (Lopressor, Toprol-XL) which are used to treat high blood pressure, coronary artery disease and migraines may be taken daily to prevent sex headaches. […] A calcium channel blocker, such as verapamil hydrochloride (Calan SR) which is also used to treat high blood pressure may be an option. […] In people who have a history of migraine, other migraine preventive medications may be used. […] Indomethacin, an anti-inflammatory, or one of the triptans, a class of anti-migraine medications, can be taken an hour before sex to prevent headaches.
#2 Primary Headache Associated with Sexual Activity: A Review of the Literature – PubMed
https://pubmed.ncbi.nlm.nih.gov/38367200/
Purpose of review: This review summarizes the evolution in diagnosis, evaluation, and treatment of primary headache associated with sexual activity (PHASA). […] Recent findings: Despite increased access to patient information and advances in imaging, the pathophysiology of PHASA remains not fully understood. […] PHASA is commonly comorbid with migraine, tension-type headache, exertional headache, and hypertension. […] PHASA can present as a dull headache that progresses with sexual excitement, or an explosive headache at or around orgasm. […] Pain is primarily occipital, diffuse, and bilateral. […] The headaches are discrete, recurrent events with bouts that typically self-resolve, but may also relapse and remit or continue chronically in some patients. […] PHASA can be treated preemptively with indomethacin and triptans administered prior to sexual activity, or treated prophylactically with beta-blockers, topiramate, and calcium channel blockers. […] CGRP-targeted therapies may provide relief in PHASA based on a few case reports, but there are no randomized controlled trials looking at specific efficacy for these therapies.
#2 Everything You Wanted to Know About Sex and Migraine (But Were Afraid to Ask!) – Association of Migraine Disorders
https://www.migrainedisorders.org/everything-you-wanted-to-know-about-sex-and-migraines-but-were-afraid-to-ask/
Whether you have migraine or not, some people experience a rare headache disorder called Sex Headache. […] The formal name of this condition is Headache Associated with Sexual activity. […] In two-thirds of people who experience sex headache the pain occurs on both sides of the head rather than one side of the head. […] In 80% of people, the pain is either widespread or located on the back of the head (occipital region). […] It usually lacks migraine features and is described as very intense pressure, the feeling as if oneâs head might explode. […] According to a paper published in 2010, Sex Headache occurs four times more often in men, and they are usually in their 40s when it first happens. […] People with a history of migraine, exertional headaches, or cough headaches may be more likely to get orgasm headaches.
#2 Don’t ignore headaches caused by sexual activity. | Vinmec
https://www.vinmec.com/eng/blog/dont-ignore-it-if-you-get-a-headache-from-sex-en
Headaches that occur during sex, while masturbating, during orgasm, or right after engaging in any sexual behavior could be a sign of an underlying health condition. It’s important to seek medical advice if these headaches become frequent or severe. […] The cause of headaches during sex is due to: in a state of excessive anxiety and emotional stress, the function of blood vessel expansion and contraction in the brain is disturbed, even the muscles in the blood vessel walls become tense, causing a temporary reduction in blood supply to the brain, resulting in headaches. […] In people with hypertension, exertion during sex can also increase blood pressure, causing severe headaches, and patients may have a stroke during intercourse. […] There are many risk factors for sexual headaches such as: Male sexuality. Men are more likely to experience sexual headaches.
#2
https://www.menshealth.com/health/a19544397/sex-headache/
About half of people who suffer from them also get headaches while they exercise, says Dr. Reitano. That gives us a hint to a potential cause: The headaches may just result from the rise in blood pressure that happens with physical activity and yes, and as your rise in heart rate during sex shows, getting busy is considered a form of physical activity. […] What’s more, the adrenaline released during sex might also contribute by increasing pressure in your brain, says integrative medicine physician Bindiya Gandhi, M.D. Contraction of the neck muscles is sometimes a culprit as well. […] Certain over-the-counter drugs like Sudafed can also contribute to these headaches by causing restriction and over-dilation of blood vessels, says Dr. Reitano. There’s also anecdotal evidence of marijuana, red wine, cheese, and other foods contributing to them, though it’s not clear why. Smoking, drinking, and being sedentary or obese can increase your risk, too.
#2 A Case of Sex Headache and Vasospasmlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/jn200408060000008/2004/08/06/case-sex-headache-and-vasospasm
Thunderclap headache (TCH) refers to a severe headache of sudden onset in which pain reaches maximal intensity within seconds or minutes (J Neurol Neurosurg Psychiatry 2002; 72:11). […] Based on this case and a review of five similar cases in the literature, the authors postulate that vasospasm is involved in the pain mechanism and that sexual arousal and activation of autonomic reflexes are necessary to trigger the pain and vasospasm. […] However, reversible segmental vasospasm has been described in patients with spontaneous TCH or TCH triggered by exertion or orgasm. […] It is unlikely that the pathogenesis of the headache and the vasospasm is significantly different in those with spontaneous TCH versus those with a trigger. […] Therefore, close clinical observation of these patients is warranted.
#2 Everything You Wanted to Know About Sex and Migraine (But Were Afraid to Ask!) – Association of Migraine Disorders
https://www.migrainedisorders.org/everything-you-wanted-to-know-about-sex-and-migraines-but-were-afraid-to-ask/
Around 60% of people with migraine reported an improvement of their headaches with sexual activity. […] Of the people with migraine who found improvement in their headaches with sexual activity, over one-third of the males and almost 14% of the females used sexual activity as a regular therapeutic tool. […] About 43% of people with migraine found that their headache changed shortly after orgasm or maximal excitement, almost 18% reported the change with the time of orgasm, 20% found the change at the beginning of sexual activity while another 20% had the change within 30 minutes of orgasm or maximal excitement. This change did not depend on type of sexual activity, partner, time of the migraine attack or position during sex. […] Unfortunately, about one-third of people with migraine who answered the survey found their headaches worsened with sexual activity.
#2
https://www.cbsnews.com/news/sex-may-be-a-natural-way-to-treat-migraines-cluster-headaches/
Thirty-seven percent of cluster headache patients said sex helped lessen the pain, with 90 percent of those patients who had sex saying they experienced moderate to complete relief of headaches. […] Study researcher Stefan Evers, a neurologist and headache specialist at the University of Munster in Germany, told LiveScience that sex releases endorphins, which are natural painkillers. […] Evers suggested that masturbation or any sexual activity may be able to get rid of headaches in some people.
#2 Frontiers | Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment
https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1373528/full
CH attacks involve activation of parasympathetic outflow, which causes typical trigeminal-autonomic symptoms such as lacrimation, conjunctival injection, and nasal congestion. […] The hypothalamus also plays a role in the nociceptive process of the trigeminovascular system and receives projections from the trigeminal nerve via the trigeminal-hypothalamic tract. […] The mechanistic relevance of the hypothalamus in CH is supported by circannual patterns, attack phenotypes, and accompanying neuroendocrine hormonal alterations, as well as by several neuroimaging studies that revealed an activation of the posterior hypothalamic region during attacks of CH. […] The activation of the trigeminal-autonomic reflex may be secondary to an activation of the trigeminovascular system; however, peripheral activation of afferent and efferent trigeminal-autonomic reflex branches is insufficient to generate CH attacks. […] The hypothalamus likely plays a central role in the pathophysiology, particularly in creating a brain state in which attacks are made possible.
#2 Frontiers | Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment
https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1373528/full
Cluster headache (CH) is a primary headache belonging to the trigeminal autonomic cephalalgias (TAC) group. […] The pathophysiology of CH still needs to be understood. The current understanding is based on preclinical, clinical, and imaging studies in patients with the disease. […] The neuroanatomical and functional systems involved in the pathophysiology of CH can be divided into three principal components: (1) the trigeminovascular system, (2) the trigeminal-autonomic reflex (sphenopalatine ganglion stimulation), and (3) the hypothalamic system. […] The interaction of these three components is responsible for the characteristic clinical presentation of CH. […] The trigeminovascular system is formed by neurons innervating the dura mater and meningeal vessels, whose neuronal body is in the trigeminal ganglion.
#2 Sex headaches | Altru Health System
https://www.altru.org/health-library/conditions/sex-headaches
In rare instances, headaches can be brought on by sexual activity especially with orgasm. […] Most sex headaches are nothing to worry about. But some can be a sign of something serious, such as problems with the blood vessels that feed the brain. […] Any type of sexual activity that leads to orgasm can trigger sex headaches. […] Abrupt-onset and slow-to-build sex headaches can be primary headache disorders not associated with any underlying condition. […] Sex headaches that come on suddenly are more likely to be associated with: A widening or bubble in the wall of an artery inside your head (intracranial aneurysm), An irregular connection between arteries and veins in the brain (arteriovenous malformation) that bleeds into the spinal fluid-filled space in and around the brain, Bleeding into the wall of an artery leading to the brain (dissection), Narrowing of the arteries in the brain (reversible cerebral vasoconstriction syndrome), Stroke, Coronary artery disease, Use of some medications, such as birth control pills, Inflammation from certain infections.
#2 4.3 Primary headache associated with sexual activity – ICHD-3
https://ichd-3.org/other-primary-headache-disorders/4-3-primary-headache-associated-with-sexual-activity/
4. Lasting from 1 minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity […] 5. Not better accounted for by another ICHD-3 diagnosis. […] Notes: 4.3 Primary headache associated with sexual activity is not associated with disturbance of consciousness, vomiting or visual, sensory or motor symptoms, whereas symptomatic sexual headache may be. On the first onset of headache with sexual activity, it is mandatory to exclude subarachnoid haemorrhage, intra- and extracranial arterial dissection and reversible cerebral vasoconstriction syndrome (RCVS). […] Multiple explosive headaches during sexual activities should be considered as 6.7.3 Headache attributed to reversible cerebral vasoconstriction syndrome until proven otherwise by angiographic studies (including conventional, magnetic resonance or computed tomography angiography) or transcranial Doppler ultrasonography. Of note, vasoconstrictions may not be observed in the early stage of RCVS; therefore, follow-up studies may be needed.
#2 Ask the Experts – Etiology of Coital Headaches
https://www.medscape.com/viewarticle/413710
The natural history of the benign explosive type of sexual headaches is variable. In a study of 26 patients, the headaches went away in 50% after 6 weeks to 6 months but recurred in 50% after remissions of up to 6 years. Headaches may be prevented in some patients by weight loss, an exercise program, a more passive role during intercourse, variation in posture, limitation of additional sexual activity on the same day, and medications. Indomethacin, ergotamine tartrate, methylsergide, or naratriptan taken before sexual activity have been reported as preventive. Propranolol (40-200 mg total per day) and diltiazem (60 mg 3 times daily) can be given as a daily preventive if this headache type occurs frequently.