# Severe headache during/after sex



## JJR512 (Feb 2, 2011)

Recently observed on a call for a male patient, age about 40. Wife called 911 for her husband who was having pain in his head. Turns out he started having pain in his head while they were having sex, but kept going. At the moment of orgasm, the pain got extremely intense, and he essentially collapsed, holding his hands to his head and moaning/crying out in pain. This is what caused the wife to call 911.

The man described the pain as 10/10, like an extremely intense pressure, and at first he said it was all over his head, but he subsequently explained it was more concentrated in both the front of his head (above his eyes going back about a third of the way back along the top), and on the back at the base of his skull.

I was actually doing an observation run on the engine at the time and don't know much more than that. He was transported.

Any idea or guesses what this could be?


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## adamjh3 (Feb 2, 2011)

A migrane exacerbated by physical exertion? I could understand how that would be really weird to someone who has never experienced migranes. 

I could be way off, though.


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## MSDeltaFlt (Feb 2, 2011)

Remember the anatomy of the skull. The area of the skull right above the eyes houses some sinuses.  Add any fluid build up in there, the probable position of him being horizontal facing down during sex, and the given increased pressure during sexual excursion, one can very easily get one incredible sinus headache the likes of which might feel like a migraine.

Also, what were his VS?  What was his PMH?  Any chronic meds?  He is 40.  Did he also use a little blue pill?

Any of these last questions can also very easily cause said pain during sex. 

Some of us aren't 19 anymore.

I'm going to treat this as Ockham's Razor: all things being equal the simplest answer is usually the correct one.


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## Anjel (Feb 2, 2011)

You could maybe take it as far as maybe a brain aneurysm? Intense headache. One spot. After a lot of physical exertion. A blood vessel could of ruptured. Or is about to. That's my guess. Could be way off lol

Or it could of just been the sinus headache


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## CAOX3 (Feb 2, 2011)

JJR512 said:


> Recently observed on a call for a male patient, age about 40. Wife called 911 for her husband who was having pain in his head. Turns out he started having pain in his head while they were having sex, but kept going. At the moment of orgasm, the pain got extremely intense, and he essentially collapsed, holding his hands to his head and moaning/crying out in pain. This is what caused the wife to call 911.
> 
> The man described the pain as 10/10, like an extremely intense pressure, and at first he said it was all over his head, but he subsequently explained it was more concentrated in both the front of his head (above his eyes going back about a third of the way back along the top), and on the back at the base of his skull.
> 
> ...



I think you may be confused, its the woman who usually has the headache and its always before sex.


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## Aidey (Feb 2, 2011)

Anjel1030 said:


> You could maybe take it as far as maybe a brain aneurysm? Intense headache. One spot. After a lot of physical exertion. A blood vessel could of ruptured. Or is about to. That's my guess. Could be way off lol
> 
> Or it could of just been the sinus headache




It isn't that crazy of a theory. I had a 50s yo male patient who stroked out during intercourse several months ago. Major hemorrhagic stroke, I'm not even sure he lived. His symptoms were 10/10 headache, zero sensation on the left side of the body (but movement was intact) and incontinence.


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## JJR512 (Feb 2, 2011)

Anjel1030 said:


> You could maybe take it as far as maybe a brain aneurysm? Intense headache. One spot. After a lot of physical exertion. A blood vessel could of ruptured. Or is about to. That's my guess. Could be way off lol
> 
> Or it could of just been the sinus headache



But I don't think it was just one spot; it was originally described as "all over" but later narrowed down to both the entire front of the head as well as the back at the base of the skull. I might have thought about an aneurysm if it was just in one single small spot (although truth be told I don't even know if that would be the case).


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## clibb (Feb 2, 2011)

I love google! 
http://www.mayoclinic.com/health/sex-headaches/DS00645/DSECTION=symptoms
http://www.headache-adviser.com/sex-headaches.html


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## EMDispatch (Feb 2, 2011)

Any ED drugs involved?
Loss of Consciousness?
Ortho-static test?

High suspicion it relates to vasodialtion from the activity.


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## emt-mike (Feb 2, 2011)

I suffer from migraines and I know that if I have a low grade migraine I wont think much of it, but often, if I exert myself (i.e. sex) it will aggravate the migraine to the point of unbearable pain (10/10) 
especially in the base of my head and at my forehead 
if it was this guys first migraine, he might not have realized he was suffering from a migraine pre sexual intercourse


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## MrBrown (Feb 2, 2011)

Hmm, could be too much contact with the headboard ask him to try being on top


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## firetender (Feb 2, 2011)

MCERT1 said:


> Any ED drugs involved?
> ...High suspicion it relates to vasodialtion from the activity.



Alzheimer's-Viagra Syndrome: 

instead of blood rushing to the Little Head, it got confused and went to the Big Head!


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## Afflixion (Feb 2, 2011)

Had a patient that was a female and complained of similar issues post intercourse, when we got on seen we checked her and her v/s were all fine other than an excruciating pain in her head she was in her late thirties early forties, and adamantly refused to go to the hospital so she signed a refusal....about an hour later her husband called up and she was unconscious unresponsive, turns out she had a subarachnoid.


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## citizensoldierny (Feb 2, 2011)

Pepper spray?


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## Sam Adams (Feb 2, 2011)

I'm guessing he didn't want to snuggle and spend the night. 

Did all his belongings come with him to the hospital?


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## MediMike (Feb 2, 2011)

Maybe he was very well...endowed...and it took a lil' too much blood from upstairs to fill the downstairs


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## Mobey (Feb 2, 2011)

What your describing is called a sex headache or Coital Cephalgia.

As an effect of my Ankylosing Spoldylitis, I have had them in the past.

Basically it is a severe headache than can lead to brief unconciouness (believed to be due to pain). The heaight of the headache is at orgasm, and is VERY painful. The headache usually lasts 30 mins after cesation of activity.

It is believed the headaches are caused by contraction of neck muscles, vascular dilation and contraction, and fluctuating BP.

Sex headaches can also be a sign of hemmorage, meningitis, and other serious illness.

There are links on P1, so I won't post more.


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## bstone (Feb 2, 2011)

http://www.ncbi.nlm.nih.gov/pubmed/20425213

Good article on the topic.


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## Smoke14 (Feb 2, 2011)

Mobey said:


> What your describing is called a sex headache or Coital Cephalgia.
> 
> As an effect of my Ankylosing Spoldylitis, I have had them in the past.
> 
> ...



Dang, I guess there is a reason to become a priest.


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## the_negro_puppy (Feb 2, 2011)

Viagra?

I've heard cases of younger people have spontaneous sub-arachnoid bleeds after sex/masturbation....


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## Melclin (Feb 2, 2011)

Mobey said:


> What your describing is called a sex headache or Coital Cephalgia..



...No Anklelosing Spiderlicious, but I've had them as well. 

Scary as f*%$. They have this run away affect that makes you think your brain stem is trying to crawl out your nose. 

Never had a headache like it. I was sure I'd blown a gasket and was ganna become a break room story for a bunch of MICA paramedics. 

My doctor thought it was a right laugh :wacko:


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## SunnyEMT (Feb 5, 2011)

34 yo female here, first had these 2.5 years ago.  Thought I was dying.  Each migraine lasted 2 days, every time for about 1 month.  They stopped as abruptly as they started and then re-occurred a year later, again over a period of about 1 month.  I've since only had 1 episode and tbh, they're so painful I daren't even try and enjoy that level of erm, stimulation for several weeks.

And sure, they occur more in men than women because way more men climax regularly during intercourse than women...


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## HotelCo (Feb 5, 2011)

Smoke14 said:


> Dang, I guess there is a reason to become a priest.



I'll take my chances. After all, what's the point of being alive, if you don't make it worth while?


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## mycrofft (Feb 6, 2011)

*People Valsalva leading to climax.*

If the vascular system is undergoing such a pressure test, defects will be discovered. Breathing (singing, screaming, talking) during climax may decrease some of the effect but also prevent effective Valsalva. Viagara or notro could conceivably contribute to it, no??

And also C1-C2 area insult or muscle tension can cause pain around the eyes via cranial nerve affect.

Either way, monitor and transport, no?


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## 8jimi8 (Feb 6, 2011)

Didn't read the posts.  My guess is some sort of vasodilatory drug.  Seen it happen enough with nitro.

Cerebral Vascular Autoregulation to be the culprit, but that's just 0.0001 seconds of critical thinking.


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