Preorgasmic and Orgasmic Headaches Are Not Migraine

Does it every feel as if some of us with Migraine and other headache disorders can't win for losing? These disorders impact every part of our lives, and intimacy with our partners doesn't get a pass.

Some people experience Migraines and headaches before or after sexual activity, and it's important to know the difference between the different Migraines and headaches that can occur at these times so we're safe and get the appropriate treatment. Diana wrote on Sex as a "Cure" for Migraine or Cluster Headache? What's the Deal?

Orgasmic_HeadacheHere, we're taking a look at another headache disorder related to sexual activity — primary sexual headache associated with sexual activity (PSH). This is a primary headache disorder, which means it's not caused by another condition. There are two subtypes of PSH:

  1. Preorgasmic headache occurs during sexual activity with the intensity increasing as sexual excitement increases. It's usually a bilateral (occurring on both sides), dull ache in the head and neck. Neck and jaw muscle tightening can also occur.
  2. Orgasmic headache occurs at orgasm and it a sudden, severe headache.

Orgasmic headache is more common than preorgasmic. In both forms of PSH, most are of short duration, however, severe pain can last for four to 24 hours in approximately 15% of patients, making treatment necessary. Treatment taken at the time of the headache is usually indomethacin (Indocin). When prevention is necessary, propranolol, a beta blocker is usually the first medication tried if the treatment is daily. If occasional pre-emptive treatment is preferred, treating with indomethacin before sexual activity can be effective. Both preorgasmic and orgasmic headache occur more frequently in men than women.

It is vital that symptoms of PSH be checked out thoroughly and diagnosed because the symptoms are similar to those of other, more serious, medical issues including subarachnoid hemorrhage, cerebrospinal fluid leaks, and arterial dissection. Diagnostic tests should be run to rule out these other conditions before confirming a diagnosis of preorgasmic or orgasmic headache.

For more detail, here is the International Headache Society's International Classification of Headache Disorders information on these two types of headache:

4.4 Primary headache associated with sexual activity1

Previously used terms:
Benign sex headache, coital cephalalgia, benign vascular sexual headache, sexual headache

Headache precipitated by sexual activity, usually starting as a dull bilateral ache as sexual excitement increases and suddenly becoming intense at orgasm, in the absence of any intracranial disorder.

4.4.1 Preorgasmic headache

Diagnostic criteria:

A. Dull ache in the head and neck associated with awareness of neck and/or jaw muscle contraction and meeting criterion B

B. Occurs during sexual activity and increases with sexual excitement

C. Not attributed to another disorder

4.4.2 Orgasmic headache

Coded elsewhere:
Postural headache resembling that of low CSF (cerebrospinal fluid) pressure has been reported to develop after coitus. Such headache should be coded as 7.2.3 Headache attributed to spontaneous (or idiopathic) low CSF pressure because it is due to CSF leakage.

Diagnostic criteria:

A. Sudden severe (“explosive”) headache meeting criterion B

B. Occurs at orgasm

C. Not attributed to another disorder1

1 On first onset of orgasmic headache it is mandatory to exclude conditions such as subarachnoid haemorrhage and arterial dissection.


An association between 4.4 Primary headache associated with sexual activity, 4.3 Primary exertional headache and migraine is reported in approximately 50% of cases.

Two subtypes (dull type and explosive type headache) were included in the first edition of The International Classification of Headache Disorders. No specific investigation has been undertaken since then to clarify whether they are separate entities. In most published reports of headache with sexual activity, only explosive (“vascular type”) headache has been reported. The dull type may be a subtype of tension-type headache, but no evidence supports this hypothesis. No firm data are available on the duration of primary headache associated with sexual activity, but it is usually considered to last from 1 minute to 3 hours.

Wrapping it up:

Primary sexual headache is not a form of Migraine. It is a distinct primary headache disorder in and of itself, with two subtypes — preorgasmic headache and orgasmic headache. It is not a form of Migraine. When diagnosing, care must be taken to rule out other conditions. When treatment is needed, it can be acute (treating the headache when it occurs) or preventive. With preventive treatment, daily preventives can be used or as-needed pre-emptive treatment.


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