Headache-Adviser.com

Thunderclap Headache

by Trevor
(Pacifica, California, USA)

Headache During Sex

Headache During Sex

Hello,
I recently had a frightening "thunderclap headache" occur at the exact moment I had an orgasm. It originated at the base of my skull but has moved up the left side and mainly presents pain behind my eye/eyes. I went to an ER and had a CT-Scan done and also a lumbar puncture which both came back normal......I was discharged as having a possible "post-coital headache" and an unspecified headache.

That was 10 days ago. Since then I have continued to have migraine type pain mainly on the left side but sometimes both. The pain level has fluctuated up and down during this period and for the most part I am not taking pain killers but occasionally take Tylenol when it is bad.

I went back to the ER yesterday as I was beginning to panic not only due to the continued pain but also because I have been having mild neurological symptoms. I feel distant/dull and I also seem to be hyper-sensitive to light as things just look a little different with my eyes either open or closed.....contrasted colors seem more vibrant or hazy.....

I had a few physical and sensory tests done by the doctor and she reviewed my previous tests and said I have a migraine and prescribed 10 mg. propranolol which does seem to be helping.

Ahhh....after all that, here is my simple question:

Does it seem reasonable that a migraine could produce these neurological symptoms for such a long time? The pain seems to be subsiding with the medication but I still feel "off" and my head feels full.

I have never had such problems before and it has been a bit frightening to say the least. I was trying to push for an MRI but the ER doctor did not think it was warranted.

Thank you for any advice or similar stories. I realize this is no place for a diagnosis but perhaps this sounds similar to other cases.....

Sincerely,
Trevor

Answer:

Hi Trevor,

Well coincidentally we saw a case today very similar to yours. CT of the head done in the ER for a headache after sex that was severe and disabling. In this case it was a woman.

One thing some doctors miss with this type of case is that rarely this type of headache can be associated with an aneurysm. Aneurysms are not too well seen on CT, but can be caught on an MRI of the brain and even better....an MRA. This looks just at the arteries.

You do not mention your age or if you smoke. Risk of aneurysm increases with a positive family history of aneurysm, hypertension and smoking.

You sound like you are in status migrainosus which is a migraine that has gone beyond 3 days. This could account for your continuing symptoms. A little propranolol and tylenol is not sufficient.

I would recommend that you try to get to a neurologist or your primary care soon to have a further work up. A short course of steroid (1-2 weeks low dose) or other medications may break the headache for you.

You should not take any migraine medication such as imitrex or other migraine meds until an aneurysm is ruled out.

If at the end of everything you do have post-coital headache,(also known as headache during sex) this is easily treated by taking naprosyn before sexual relations.

Good luck!
Mary Kay Betz MS RPA-C

COMMENTS:

Perfect timing.I am 42 years old. I have had these headaches for about three years. Not often though. The last one was a doosy and I honestly thought that it was my time to go. I had a dull headache for a month, but I could feel the sharp pain come back if I allowed myself to have an orgasm. so...orgasms were out of the question. my husband pushed me enough that I finally went to see neurologist, he described these as common but since the last one hung around he was concerned. Monday I go in for MRI/MRA to rule out sentinel aneurysm. I have a stiff neck but have good ROM...just feels like muscle soreness. Ill update if anything comes from Monday tests. I will say he put me on low dose nodolol and imitrex.

Answer:

Hi,
Just wanted to let you know that those are both good choices for now until the MRI/MRA. If migraine is diagnosed, and the nadalol is of no help, consider topiramate or depakote.

You might also do well on magnesium (400mg-800mg/day) for prevention, which helps not only nerve tissue but also the smooth muscle tissue that lines blood vessels. This might prevent the headaches to begin with.

Also pretreat with 2 Aleves before relations which might help.

Good luck..I will post any other comments as they come in.

Mary Kay

like you i had one that lasted over 3 months. i had a lumbar tap and ct scan, all showed nothing. I don't have insurance so i was not really treated. i was totally incapaciatated that entire time. I thought I was dying. I couldn;t eat and the pain was worse than anyting i had ever ecpierenced . In fact I had decided that if it did not stop soon I would end it myself. No i am not suicidal but the pain was that bad. I am still terrified of having orgasms and in fact i stop before i do. I am a 40 year old woman who does smoke. So if anyone has any ideas what was going on please tell me!!!

Answer

Hi,
If you read the posting and search thru the site (headaches during sex) you will see that benign coital headache is quite treatable with a low dose of a generic medication. Some people do well with Naprosyn 500mg before having intercourse.

By all means see your doctor. You may be pleasantly surprised and the headache needs to be treated.

Mary Kay

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Thunderclap Headache

by Sherri
(palm beach)

Disabling Headaches

Disabling Headaches

I am a migraine sufferer to begin with. I have recently been under tremendous stress with horrible family news and the stress has increased the migraines. I have also had lately 3 thunderclap headaches, I went to see my primary, they checked my blood pressure it was very low at around 110/75 i believe it was. It is always low, i never have a problem with it.

My family doctor said they are nothing to be concerned about at this time, from my history... however I have never had an MRI or scan of any kind... should I be concerned any further? or are the migraines and the stress and low blood pressure enough to go by? The very last one i had was more mild than the first.

Sherri

Answer:

Hi Sherri,

By definition, a thunderclap headache is one that is painful enough to bring you to your knees in a matter of seconds. It is not a slow building headache. You do not mention whether these three headaches were associated with nausea or vomiting or if they "felt" like your regular migraines. If they did, but just worse in pain, your doctor may be right.

However, it is concerning that with a change in your headache profile you did not get an MRI. This is one of those "neuroimaging flags" that we in neurology look out for..so I do think you need to get one.

One of the things to be concerned about is obviously, an aneurysm. Many times an aneurysm will present with sentinel headaches that the patient was having for weeks before it burst. You may want to ask for an MRA also, which looks at the arteries of the brain. This is especially important if you are over the age of 50 and have any past history of smoking. The low blood pressure is in your favor as far as risk of stroke or aneurysm is concerned, but it is not really tied to the frequency of migraine.

If you are over the age of 50 and the headache is on one side, then temporal arteritis may be of concern.

If everything is clear, then take a look at getting a break from the stress. Notice I didn't say get away or ignore, but just take a break..go out with friends, lean on someone you trust. This will allow you to cope with the family issues without getting such bad headaches.

Good luck!
Mary Kay Betz MS RPA-D

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