The last thing anyone wants is for sex to be a headache. For some people, though, an increase in sexual excitement can be a real pain in the neck.

Primary headache associated with sexual activity (PHASA) describes at least two bouts of pain in the head or neck brought on by sexual activity. The headache can escalate gradually during sexual activity or it can be an intense headache just before or during orgasm.

PHASA can be intense for between a minute to 24 hours or mild for up to three days. The most common type is a rapid intense headache at or around orgasm. These headaches are two to four times more common in men than women.

It's estimated that the condition – also known as sex headache, coital headache, orgasmic headache and coital cephalagia – occurs in 1-1.6% of the population at some time in their life. However, the real figures could be higher – PHASA often goes unreported, most likely due to stigma around discussing sex.

The reasons why sex headaches happen are not fully understood but, since people with hypertension are more likely to get PHASA, they are likely associated with high blood pressure.

PHASA is also commonly found in people who normally suffer from headaches or migraines. Sex headaches could also be caused by abnormalities of the veins around the head and neck. Studies found that venous stenosis (a narrowing of the veins) and headaches triggered by coughs or exertion are associated with PHASA.

In April 2024, it was reported that a 61-year-old woman in the US suffered a brain bleed after having sex. The woman, not realising it was a bleed, took an aspirin for the headache.

Aspirin is a blood thinner and, while useful for people who might be at risk from ischaemic stroke (a blocked blood vessel), it could be disastrous for someone with a bleed. This woman took three aspirin which may have contributed to her bleed but thankfully, according to reports, she has now made a full recovery.

Brain bleeds while having sex are more common than you might think. Other forms of physical exertion can also bring on a stroke including running, lifting heavy weights, even sneezing, straining on the toilet, playing the trumpet, and bouts of laughter.

In the US, up to one in 12 patients going to the Emergency Room because of a brain bleed were having sex when the pain started.

A hole in the heart could be a risk factor for stroke during sex. The hole in the heart, or patent foramen ovale (PFO), is a small flap-like hole between the top two compartments (atria) of the heart. This hole is seen in everyone prior to birth and typically closes just before birth.

In a case report of three "unusual triggers for stroke" two of the three patients had PFO. One stroke was brought on by sex while the other from a bout of laughter. Another study has found PFO to be common in people who have a stroke during sex.

A more recent US study trawled medical records for patients who had had an intracranial haemorrhage (brain bleed) during sex. They found 16 recent cases. The average age of these patients was 50, and 13 of the 16 patients were male. Thirty one percent had hypertension.

Half of the patients had an aneurysmal sub-arachnoid haemorrhage – a burst blood vessel in the brain or ruptured brain aneurysm. Two of the 16 had an arteriovenous malformation – a tangle of blood vessels – and two had a deep brain haemorrhage.

If you have had a headache during sex, then you should certainly see your doctor, who can treat you with drugs typically used for hypertension, including beta-blockers and calcium channel antagonists. The doctor might also suggest a more "passive" role during sex or even abstinence while further tests are done to rule our more worrying explanations.

Much is still unknown about who is at risk of stroke during sex. However, if you are a male of around 50 years of age who has experienced a headache during sex you might want to get yourself checked out for an aneurysm or hole in the heart.

It is likely that your headache can be treated quite easily, but there will be some people with unknown and potentially serious underlying health conditions.The Conversation

Colin Davidson, Professor of Neuropharmacology, University of Central Lancashire

This article is republished from The Conversation under a Creative Commons license. Read the original article.