Brief Answer:
Coital Headache

Detailed Answer:
Good evening. I am Dr. Saghafi and an Adult Neurologist as well as Headache Specialist. Your experience, believe it or not, is not that uncommon. The type of headache you suffered from is referred to as COITAL HEADACHE. It is characterized by sudden and excruciating pain which comes on without warning, is just before or right at climax, happens mostly in males, and can be so debilitating that it often stops people immediately before even completing any act.

It is unclear why these types of headaches start at any particular age (i.e. why did it choose to start now at age 34 since this is probably not the first time you've orgasmed in your life) but it tends to happen in middle aged people. There are 3 types of these types of headaches and by your description I would say you are suffering from Type 2 which comes on explosively, nearly at the moment of orgasm, and is usually localized to the back of the head (occipital lobe area).

Many times these headaches can unmask or mark the beginning of a headache disorder which can be migraine type, tension type, or exertional types of headaches. This is likely the explanation of why you continue for 2 weeks now to have terrible headaches which it seems you've never had before.

In some cases these types of headaches are representations of something more sinister or insidious in the head such as an aneurysm or other malformation in the brain. In your case, however, a good workup (actually a GREAT workup) was done which included a spinal tap and everything was negative. I looked at your MRA scans and they look pristine. No evidence of an aneurysm, AVM, or bleeding.

What you're feeling is simply the residual and very possibly the unmasking of a headache disorder (probably migraine from your description).

The treatment for these headache (and you're going to like this one..well, maybe) involves recommending MORE FREQUENT SEXUAL INTERCOURSE...but LESS STRENUOUS....Medication wise one can use either propranolol or indomethacin as prophylactic. My preference to my patients is to recommend indomethacin 25 or 50 mg. about 1-2 hrs. prior to intercourse and only on the days of intercourse or other sexual activity where you expect to get to orgasm. Propranolol is also used, however, that medication needs to be taken a few days ahead of time in order to get up to good blood levels and my feeling is that it is not as effective as prevention of these headaches as indomethacin.

There is a downside to indomethacin and that is many people experience intolerable GI side effects and even darkening of the stools which indicates likely GI bleeding caused by the medication. In those cases the medicine needs to be stopped.

If this answer satisfactorily addresses your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback on your part.

Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived expeditiously for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best

The query has required a total of 27 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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