What should you know about coital cephalalgia?

The pain may build as arousal increases or reach a sudden peak around orgasm. It can feel throbbing, pressure-like or severe, and may affect the head or neck. Many headaches have benign triggers, including dehydration, heat, infection, sinus symptoms, stress or muscle tension; examples include Common Cold, COVID-19, Dehydration, Heat Exhaustion, Allergic Rhinitis and Chronic Sinusitis. Those possibilities do not explain away a new abrupt headache. A clinician must consider more serious causes, including bleeding or problems affecting blood vessels.

Stop sexual activity when pain starts, rest in a safe place and avoid driving if the pain is severe or your vision, balance or alertness is affected. Note when the pain began, how quickly it peaked, where it was felt, associated symptoms, recent illness, fluid intake and medicines. Avoid restarting sexual activity until a clinician has assessed a first or unusual episode. Do not self-treat repeated severe headaches with frequent painkillers without advice.

Call emergency services for a thunderclap headache, loss of consciousness, seizure, new weakness or numbness, difficulty speaking, confusion, fever with a stiff neck, repeated vomiting or vision loss. Seek urgent assessment for any first sudden severe headache during sex, even if it improves. Recurrent episodes also deserve a medical review.

Ask whether your headache pattern needs urgent imaging or other tests, which warning signs require emergency care, and when sexual activity can be resumed. Tell the clinician about blood pressure, infections, new medicines and any history of migraine or anxiety.