Sex-Triggered Headaches No Joke to Doctors
Modern research has cast new light on a phenomenon known since at least the time of Hippocrates, who is the first medical expert known to have referred to sudden, severe headaches during sex--a problem that may affect 250,000 American men and women.
And now, with publication of the 21st major study of a phenomenon that has acquired the arcane clinical appellation “benign sexual cephalagia,” experts are calling for increased sensitivity to a problem possibly far more common than doctors and their patients think.
It is a scientific reality that is a variation of the familiar cliche: “Not tonight, dear, I have a headache.”
Cephalagia is medical jargon for headache and the problem in question is a particularly virulent form of headache that comes on with the force of a severe migraine during sex--usually just at or slightly after orgasm.
The throbbing headache can continue for as little as just a few minutes or as long as more than 24 hours. A sufferer may even experience nausea and vomiting.
It occurs more often in men than in women but apparently, it affects both sexes in significant numbers. In some studies, three-quarters of the victims were male. While some researchers have reported that a few patients identify headache intensity with upright lovemaking positions, most find little relationship between technique and headache occurrence.
Benign sexual headache has been reported in both heterosexual and homosexual intercourse as well as masturbation.
Because talking about it even to a trusted physician is something patients find acutely embarrassing, headache experts and other neurologists admit there is no reliable way to determine how common the disorder may be. One researcher found his patients had delayed calling the problem to the attention of their doctors for intervals ranging from a month to three years.
As early as 1974, a research team in Columbus, Ohio, examined 14 patients suffering from the syndrome and concluded that lovemaking “is a previously underemphasized or ignored . . . setting which can precipitate headaches.”
Renewed Interest
New attention was focused on benign sexual headache three weeks ago with publication of a report by a Boston neurologist, Dr. Donald Johns, of four sisters who each experienced the disorder--while their 25-year-old brother was symptom-free.
An internationally known expert--Chicago’s Dr. Seymour Diamond--said he believes as many as 250,000 Americans may suffer from benign sexual headache. The attacks may strike without warning and disrupt lovemaking for days, weeks or months and then vanish as mysteriously as they began--only to resume again with equal suddenness.
Often mistaken by physicians as the possible signs of an imminent stroke, benign sexual headache only rarely is associated with any truly lasting or life-threatening physiological disorder. But its very nature may lure doctors trying to treat it into failing to subject such headache victims to tests--starting with sophisticated X-ray scanning--to separate the rare pre-stroke victim from far more common benign sexual headache sufferers, who can often be treated with a variety of pain relievers and muscle relaxants, Diamond and other experts said.
Doctors occasionally have also found that, for reasons that are not entirely understood, such unlikely steps as eliminating the artificial sweetener Nutrasweet (generic name: aspartame) from the diet or, in the case of women, discontinuing birth control pills sometimes is a preventive.
Johns’ article appeared in the November issue of Archives of Neurology, but the study hardly represented a new discovery. Johns noted that Hippocrates, the father of modern medicine, had himself associated headaches with “immoderate venery” in the 4th and 5th centuries BC. Hippocrates appears often in footnotes to modern-day studies of the problem.
At one time, doctors believed sexual headaches were a variant on the kind of intense throbbing that can occur in physical exertion. Runners, for instance, have often complained of migraine symptoms in periods of heavy training.
Not Linked to Exertion
As research continued, though, experts came to conclude that sexual headaches aren’t true exertional headaches at all, and that there may be a total of three distinct types. The first type is a so-called muscle-contraction variety that is likely brought on by the flexing of muscles in the neck and upper body during intercourse. Treating the muscular variety can include teaching relaxation techniques, including biofeedback.
A second variety of sexual headache--and the most common, according to Johns and others--is precipitated by pronounced contraction of blood vessels in the head and neck. It can often be successfully treated with drugs developed for treatment of high blood pressure. A very rare third variety of headache can occur when unusually vigorous sex precipitates a slight tear in tissue lining the spinal cord and spinal fluid escapes.
“From my own experience (I’d say sexual headache) is more common than is generally appreciated,” Johns said in a telephone interview. “You have to get to know the patient before they tell you the kind of detail you need (to identify the problem).”
Patients’ reluctance to seek medical attention is thought to be a major factor in exacerbating sexual headaches--since, many experts say, the various syndromes can often be treated successfully. Patients, agreed Johns and Diamond, often succumb to shame, with the disabling severity of the headaches sometimes leading to impotence and prolonged absence of desire.
A Possible Warning
A major problem in sexual headache patients, Diamond said, however, is that the symptoms in question can--with enough frequency to concern physicians--be precisely what they may seem to be: The first signs of a possible stroke or stroke-like illness.
“Anybody who has this condition should be (examined) by an internist or a neurologist,” Diamond said in a telephone interview. A problem, he said, may be that many primary care doctors either don’t know that a description of a severe headache during sex may fit a widely recognized pattern. Many physicians also share the embarrassment of their patients at discussing such issues, he said.
“I think it’s important that, if a person comes in and mentions it to the family physician or an internist or, if it’s a woman, to her gynecologist, that it not just be sloughed off. I think it’s a symptom important enough that physicians should pay some attention to it.”
While both Johns and Diamond emphasize that sexual headache complaints should be taken seriously, each has heard his share of predictably snide remarks, focusing on the “not-tonight-dear-I-have-a-headache” cliche. “A lot of my physician colleagues have made that same bad joke,” Johns said.
But Diamond--who’s heard similar comments--said he figures the motto needs a little editing. “The cliche assumes the headache precedes sex,” he said. “It should go this way: ‘Dear, what we’ve done tonight has given me a headache.’ ”
