Primary Sex Headache


Primary sex headache as the name suggests is precipitated or aggravated by sexual excitement. The head pain of primary sex headache begins as dull aching headache which is bilateral and suddenly become intense headache at the time of orgasm.


Primary sex headache is more common among men than women and it can occur any time during the sexually active years. In some individuals primary sex headache occurs in repeated succession and disappear once and for all and it does not trouble again even if there is no change in sexual activity. In half of the patients with primary sex headache, it subsides within 6 months without any explanation.


What are the types of primary sex headache?

There are 3 types of primary sex headache. (1) A dull aching type of pain in the head and neck that intensifies as sexual excitement increases, (2) an explosive, very severe type of headache that occurs at the time of orgasm, and (3) a postural headache that occurs after sexual intercourse and have resemblance to low CSF pressure headache, which is a type of low CSF pressure headache, that arises due to intense sexual excitement and sexual act.


What are the causes of primary sex headache?

Mostly primary sex headaches are benign in nature with no serious underlying pathology. In 5-12% of primary sex headaches are due to subarachnoid hemorrhage. Patient with primary sex headache may have exertional headache, migraine etc.


How primary sex headache is treated?

If the primary sex headache is benign in nature, no treatment is required other than reassurance advice about stopping sexual activity when a mild, warning headache develops. The benign primary sex headache occurs infrequently and irregularly and generally of milder in nature and intensity. Generally preventive treatment is given in primary sex headache, rather than treating when it occurs.


How to prevent primary sex headache?

Propranolol can be used in primary sex headache to prevent the recurrence. The dose of propranolol for prevention of primary sex headache from recurring varies from 40 to 200 mg/day. Alternative to propranolol includes calcium channel blocking agents such as diltiazem (60 mg 3 times a day). Drugs such as ergotamine (1 mg) or indomethacin (25–50 mg) if taken 30-40 minutes before sexual act can also be used for prevention of primary sex headache. If sexual activity is immediately stopped at the first sign of headache, it may subside in 5 minutes to 2 hours.


Primary sex headache can also be prevented or reduced by stopping sexual activity before orgasm (it is an impracticable solution to prevent primary sex headache).

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