Headaches in Men

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Although headaches can occur in both men and women, it is important to point out two different types of headaches that occur more often in men that involve sexual stimulation and orgasm. 

The two types of headache that are affected by male hormones/sexual activity are sex headaches (also called ejaculation headaches or post-ejaculation headaches) and cluster headaches.  Since the central nervous system is tied closely with reproductive functions, it is possible for shifts in testosterone levels and even high intensity sexual stimulation and orgasm to either trigger or relieve certain types of headache pain.

SEXUAL HEADACHES

(Coital Cephalgia)

This type of headache occurs in about 1% of men and is triggered by sexual activity.  Although they can occur in both men and women, men are three times more likely than women to experience sex headaches.  These headaches seem to appear from nowhere.  They can occur suddenly most often between two different age brackets, men who are 20-24 and men who are 35-44 years of age (age 39 being the overall average).[i]  In addition, men who have other types of headaches, like migraines are more likely to experience headaches than other men.

There are two subtypes of sex headaches.  The first is called Type 1 which is dull, slow building headache that worsens as sexual stimulation increases.  The second is called Type 2 and is often an explosive or “sledgehammer to the head” pain that occurs during climax (often at orgasm).  In many cases, these two types of headaches overlap – where a man will start getting a dull headache with sexual stimulation that will continue to build as he become more stimulated, and will culminate with a severe headache right about the time he ejaculates. 

Type 1 sexual headaches or pre-orgasmic headaches often build as sexual stimulation increases.  This often occurs in the rear of the head and the neck muscles (three-fourths of the time) and can affect both sides of the head as well (two-thirds of the time).[ii]  This is thought to be caused by muscle tension mounting as sexual stimulation increases.  Areas of pain and tension in type 1 are shown below:

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Type 2 sexual headaches or orgasmic headaches are more common and are thought to be caused by blood vessel constriction and spikes in blood pressure that occur during orgasm.  They often start in the rear of the head the rapidly spread to most of the head as shown below.[iii]  They are thought to be caused by abnormalities in the blood vessels in the brain that are sensitive to increased neural firing that occurs during sexual activity. 

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It’s always a good idea to see a healthcare provider about severe headaches to ensure that there are not issues occurring inside the brain.  However, in most cases, sexual headaches are not a sign of anything major; however, it’s still worth checking out. 

Medications can be used to help prevent sexual headaches.  Some medications like beta blockers can be used to relax the arteries in the brain which may help prevent sex headaches in some men.  Men who are prone to migraines may be prescribed a triptan (a type of migraine medication) one hour before sex to try to prevent the headache from coming on.  Men may also be prescribed a type of anti-inflammatory pain reliever called indomethacin an hour before sex to prevent a sex headache.  In some men where headaches are thought to be caused by spikes in blood pressure or vessels spasm can be dosed with propranolol prior to sexual activity. 

Non-drug treatments often involve changing sexual behavior.  For some men, more frequent, less vigorous sexual activity has been shown to be helpful.  For others, sexual abstinence for a couple of weeks has eliminated the headaches.  Yet for others, simply changing sexual positions can be helpful.  Men who tend to get tension type headaches in their neck may be encouraged to change sexual positions to something less upright to prevent or relieve tension in the neck muscles in hopes of not triggering a headache.  For others, lying down after sexual activity rather than sitting or standing up can help blood pressure drop and reduce the duration of the headache. 

Because sex headaches may be due to different causes, not every medication or non-drug treatment will work for every man.  Oftentimes this results in men and healthcare providers trying a variety of non-drug as well as medication treatments before finding a combination that works best for that particular individual.

 

CLUSTER HEADACHES

Cluster headaches are often described as the worst type of headache pain known.  The pain typically comes on fairly quickly – usually pain can go from non-existent to the most severe pain in 5 minutes or so.  The pain is typically localizes on one side of the head, usually behind one eye.  The headache can last from 15 minutes to 3 hours if not treated.  Many people with cluster headaches describe the pain as being jabbed in the eye with a hot poker and they often relay they would rather have a broken bone than a cluster headache.  Clusters often cause intense pain, sweating, and tearing of the eye on one side of the body, while oftentimes the other side of the body, head, and eye are unaffected.  Men complain of extreme restlessness which often leads to them pacing, tossing and turning, and trying to get into a comfortable position without success.  Cluster headaches occur in men much more often than they do in women. 

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Cluster headaches can spread from behind the eye to the same side of the head (typically just pain on one side of the head but not the other) as show below:

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They are called cluster headaches because they tend to cluster around certain times of the year.  The most common time of year is around the shortest days of the year (December/January).  However, some men get them around the longest days of the year (June/July) and other men get them twice a year (in the spring and in the autumn) when the days are about the same length.  They also tend to cluster at the same time of day (often an hour or two before going to bed or after waking up).  But they can also happen randomly throughout the day.  Oftentimes, the headaches will occur almost daily during this cluster period; however, outside of this time of year, men will typically have no headaches at all.

Cluster headaches are triggered by the hypothalamus, which is involved in regulating sleep/wake cycles.  Sleep/wake cycles are sensitive to light input from the eyes and thus on the length of sunlight received each day.  It is thought that a certain level of light input activates the hypothalamus triggering the cluster headache.  Since the hypothalamus is also responsible for controlling sexual drive and the pituitary gland – seasonal shifts in sex hormones may contribute to cluster headaches. 

Many men desire to prevent cluster headaches when they start approaching the time of year when cluster headaches occur.  The medication verapamil, which relaxes blood vessels, is often used to prevent cluster headaches.  However, mounting evidence is now showing that seasonal shifts in certain hormones that affect the hypothalamus may be a cause of some cluster headaches in men.  The main hormones are testosterone and melatonin. 

Testosterone as we discussed earlier is affected by vitamin D.  Vitamin D is synthesized in the skin by sunlight, so during the winter months, vitamin D levels can drop causing testosterone levels to drop as well.  When longer days come back, vitamin D levels rise along with testosterone.  On the other hand, melatonin is released by the pineal gland when it gets dark.  This helps trigger a sleep cycle.  As longer and shorter days set in, it is thought that the shifting of the time of darkness can negatively affect the sleep/wake functions of the hypothalamus also potentially triggering cluster headaches.  Because of this, some healthcare providers suggest that men with a history of cluster headaches take supplemental over-the-counter vitamin D3 starting about a month before cluster headaches normally start to keep testosterone levels elevated.  Adding zinc 25mg at night can also help keep testosterone levels higher during the winter months in order to help prevent cluster headaches.  In addition, adding melatonin at the same time each night before going to bed can help keep the sleep/wake cycles on a consistent rhythm thus potentially preventing cluster headaches as well.

Once a man has a cluster headache, relieving the pain is one of their main goals.  Oxygen is used in the emergency room setting.  Some men, especially those who also have migraine headaches, will respond to migraine medications called triptans. 

However, just as hormones can trigger cluster headaches, other hormones like oxytocin have been suggested as eliminating cluster headaches.  Oxytocin is released by the pituitary gland in men during ejaculation and orgasm.  Nearly three in four men will have their cluster headache go away during ejaculation/orgasm.  For most, the pain almost immediately starts to subside when ejaculation occurs and rapidly diminishes over a couple of minutes to nearly no pain at all.  For many men, sexual activity needs to be engaged in before the headache reaches its full pain potential since severe pain can make it difficult for a man to achieve an erection and ejaculate.  Since cluster headaches set in rapidly, men who find ejaculation relieves their pain typically need to engage in sexual activity at the first sign of a cluster setting in and try to achieve orgasm as quickly as possible to stop the headache in its tracks. 

 

[i] Frese A et. al.  Heachace assocated with sexual activity: demography, clinical features, and comorbidity.  Neurology, 2003 Sep 23; 61(6):796-800.

[ii] Frese A et. al.  Heachace assocated with sexual activity: demography, clinical features, and comorbidity.  Neurology, 2003 Sep 23; 61(6):796-800.

[iii] Cutrer, FM, Headaches Associated with Exertion and Sexual Activity, Information for Health Care Professionals, American Headache Society.

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