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|Classification and external resources|
Also known as "sexual headaches", coital cephalalgia is a rare type of severe headache that occurs at the base of the skull before orgasm during sexual activity, including masturbation. A pressor response to exercise has been suggested as a mechanism.
The pain usually moves from the base of the skull through the head towards the frontal lobes. Extremely severe and sharp pain behind the eyes is also a symptom. The headaches usually have an immediate onset, with some gradually worsening during sexual intercourse and others (referred to as "explosive headaches") occurring almost instantaneously at the moment of orgasm. The headache is usually worsened by movement. These headaches typically last for a few minutes to a few hours, although it is possible for such headaches to last up to a few days. 
Coital cephalalgia can frequently occur in a timeframe that exertion headaches occur.
It is most common for men to experience these headaches for the first time in their early 20s, or between the ages of 35-44; the reason for this is unclear.
More prevalent in men, by a ratio of 3:1, these headaches appear in roughly 1% of the population, though it has been suggested that the prevalence may be higher, due to the embarrassment of presenting with the disorder, especially in cases where spontaneous remission occurs after a few days. Up to 10% of patients taking medication for erectile dysfunction may experience these headaches. If such symptoms are experienced by a patient, it is important for a physician to rule out a potential brain aneurysm, or tumors. In most cases, these headaches are benign. More serious symptoms include a stiff neck, confusion, dizziness and and the most extreme cases, death.
As for treatment, a physician may recommend reducing heavy sexual activity and masturbation for a short period of time ranging from a few days to a few weeks. In addition, physicians may recommend medications such as Propranolol that can be taken in advance of sexual activity to prevent such headaches. Reduction in weight to a more ideal level and increased exercise may also reduce the likelihood of recurrences. A physician may wish to order a CT scan to exclude intracranial bleeding or a mass lesion as a cause for this pain, however, in the absence of other symptoms this may not be routine. Indomethacin has also been tried.
- Staunton, H P; Moore, J (1978). "Coital cephalgia and ischaemic muscular work of the lower limbs". Journal of Neurology, Neurosurgery & Psychiatry 41 (10): 930. doi:10.1136/jnnp.41.10.930.
- "Sexual Benign Headaches". National Headache Foundation. Retrieved 4 January 2013.
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- Medscape: Etiology of Coital Headaches
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- Delasobera, BE; Osborn, SR; Davis, JE (2012). "Thunderclap headache with orgasm: A case of basilar artery dissection associated with sexual intercourse". The Journal of emergency medicine 43 (1): e43–7. doi:10.1016/j.jemermed.2009.08.012. PMID 19818575.
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- Mauri, G; Vega, P; Murias, E; Vega, J; Ramón, C; Pascual, J (2012). "Fusiform aneurysms of the vertebral artery: A hidden cause of exertional headache?". Cephalalgia 32 (9): 715–8. doi:10.1177/0333102412449928. PMID 22684099.