DR. HOOK- Not tonight: When the headache joins the joining

Sex causes a major headache for many people. John Edwards finally admitted to have sex with another woman, while his wife battles breast cancer. Hopefully, the main reason he has a headache now is that his wife conked him on the head. 

Danny Bonaduce (aka Danny Partridge) married a woman on their blind date because she refused to have sex with him unless they were wed. I think being married to Bonaduce would give anyone a headache. Senator Larry Craig probably wished he never wanted sex because the airport bathroom scandal is a major headache for this homophobic hypocrite. I don't know how he can deny what he did since in the taped interview, he gave blow-by-blow details of the account.

So should it be any surprise that the actual act of sex can cause a terrible headache?

There are two types of sexual headaches: pre-orgasmic and orgasm. Pre-orgasmic headaches are a type of tension headache due to tightening the jaw and neck muscles. So as the excitement grows, the headache gets worse. (Sounds more like manual labor than making love.) The pain tends to be dull, band-like, and usually goes away 30-60 minutes after climax. 

For those with pre-orgasmic headache, relaxation is highly recommended. Let the other person do the work! I wonder if there are meditation classes for this– but then again nothing would ever happen. 

Orgasm headaches are usually very painful. No pun intended, but they have an explosive onset just before or during orgasm. Talk about raining on your parade! The pain is throbbing, like a migraine headache, and can even have associated neurological symptoms– like numbness or tingling of body parts.

Can you imagine having an orgasm headache– you're in pain, miserable, and confused— and then your partner says, "Wow, couldn't you just tell me if I'm not satisfying you?"

Unfortunately, orgasm headaches are associated with strokes. Not sure how many folks will go on to have a stroke, but 12 percent of people with a subarachnoid hemorrhage (a type of bleed in the brain) report having had sex when the stroke occurred. Rarely, a sexual headache is a tip off there is a bleed in a brain tumor. So a brain MRI and MRA might be needed (though I wonder if health insurance will cover it).

Twenty five percent of folks with sexual headaches have migraine headaches already, 29 percent have benign exertional headaches, and 45 percent have tension headaches. So it's hard to know if the orgasm headache is a warning sign of an impending stroke.

There aren't many studies about sexual headaches because most people don't bring it up to their doctors. Also, the sexual headaches normally don't occur every time with sex. In three years, 69 percent of cases go away. One Danish population-based study reports a lifetime prevalence of 1 percent. A German study reports men have it about three times more than women.

Some things might cause a sexual headache, like some meds. Pseudoephedrine is a decongestant that can raise blood pressure to make your head feel like it will pop off. Oral contraceptives raise BP as well, and are known to make migraines worse. (Great! You can relax about not getting pregnant, but then worry your orgasm will feel like an atomic bomb in the head!) Marijuana can cause a sexual headache, but then, would that person care? Folks with low blood sugars, particularly diabetics, can suffer headache as their sugars drop during sex. Sinus infections, anemia, low thyroid, COPD, and some hypertensive disorders all are guilty.

 Some medicines can help prevent sexual headaches or immediately treat them. Hopefully they are benign and will go away. Otherwise, there might be a lot of, "Not tonight, honey– I might get a headache."