Oct. 30, 2002 -- All "not tonight, dear" jokes aside, it appears there really is an association between headaches and sex. Experts say that although severe headaches brought on by orgasm are uncommon, men are three times as likely to get them as women.

While sexual headaches may spoil the mood, they are generally not linked to serious health problems. But they shouldn't be ignored, says headache specialist Merle Diamond, MD, because this is not always the case.

"The vast majority of these headaches are totally benign, but it is also possible that they can be caused by a space-occupying lesion in the brain, like a tumor or an aneurysm," she tells WebMD. "It is important to rule out these things, even though they are rare."

In the largest study to date of people seeking treatment for sex-related headaches, researchers from Germany's University of Munster found that the headaches typically occurred over the course of a few weeks and then resolved spontaneously. Many patients did not have the headaches again, but some reported frequent headaches.

"We saw one patient who had close to 200 attacks," researcher Achim Frese, MD, tells WebMD. "But the majority of patients had spontaneous remissions. That suggests that if a patient receives treatment, it should only be given for a short time."

Most patients seeking treatment reported explosive and very severe headaches starting around the time of orgasm, but some had dull headaches in which the pain increased more gradually. Roughly half of the patients said they were able to lessen the severity of the headaches by slowing down the period of sexual excitement.

The researchers concluded that these types of headaches occur in men between the ages of 20 and 25 and again in men between the ages of 35 and 45. Frese and colleagues reported their findings this week at the European Federation of Neurological Societies congress in Vienna, Austria.

It is not known why sexual headaches -- and other exertion-related headaches -- occur. But Diamond tells WebMD that they may be triggered by the adrenaline that floods the body during intense activity.

"There is this adrenaline rush and then a letdown phenomenon when orgasm occurs," she says. "It is one theory, but the chemical basis of what is going on is not really understood."

Diamond says migraines are common among people with headaches linked to sexual release and patients often respond well to treatment with the prescription nonsteroidal antiinflammatory drug Indomethacin. Frese says beta blockers, commonly used to prevent and treat migraines, are also highly effective for sex-related headaches.

"The good news is that there are treatments available, and they work," says Diamond, who is associate director of the Diamond Headache Clinic in Chicago. "You don't have to swear off sex."

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