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Primary headache associated with sexual activity

F Michael Cutrer, MD
Section Editor
Jerry W Swanson, MD, MHPE
Deputy Editor
John F Dashe, MD, PhD


Headache associated with sexual activity has also been referred to as sexual headache, benign vascular sexual headache, coital cephalalgia, coital headache, intercourse headache, (pre)orgasmic cephalalgia, and (pre)orgasmic headache. It is one of several relatively uncommon headache syndromes that may occur either as a primary headache or as a headache caused by a potentially malignant processes. Careful evaluation for underlying causes is important for these uncommon types of headache.

This topic will review primary headache associated with sexual activity. Other types of uncommon primary headache disorders are discussed separately. (See "Primary stabbing headache" and "Primary cough headache" and "Exertional headache" and "Hypnic headache" and "Approach to the patient with thunderclap headache" and "Nummular headache".)


The cause of primary (benign) headache associated with sexual activity is unknown and the proposed pathophysiological mechanisms are largely speculative. Benign sexual headaches are difficult to study because of their relative rarity and variable clinical presentation. One investigator proposed that preorgasmic headaches arise from excessive contraction of neck and jaw muscles during sexual activity and that they might be avoided by conscious relaxation of these muscles during intercourse [1]. Orgasmic headaches have been attributed to rapid increases in blood pressure and heart rate that occur during orgasm [1].

The occasional occurrence of transient neurologic symptoms such as numbness or paresthesias with sexual headaches has caused some authors to suggest that benign sexual headache should be considered a variant of migraine caused by hemodynamic shifts during orgasm [2-4]. Although many of the patients in reported case series of sexual headache also have a history of migraine [5], the high prevalence of migraine might result in co-occurrence of the two disorders. Therefore, the attribution of sexual headache to migraine without rigorous investigation of potential underlying causes is probably unwise.

Several investigators have noted a possible relationship between sexual headache and exertional headache [6-8]. As an example, a retrospective study of 45 patients with primary sexual headache found that 40 percent had also experienced primary exertional headache on at least one occasion [6]. Presumably, physical exertion associated with sexual activity can be one of the factors that precipitate exertional headache in those who are predisposed. (See "Exertional headache".)

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Literature review current through: Nov 2017. | This topic last updated: Jul 03, 2017.
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