Headache Associated with Sexual Activity

by Carl Ellenberger MD

With an orgasm comes a thunderclap in the head, a crashing headache. That could scare you out of your wits! What to do? It's too late to "ask your doctor if you are healthy enough for sexual activity," as the gratuitous sotto voce Viagra marketing slogan implores.

The surprising number of Mt. Gretna residents who have consulted me for this symptom has led me to consider several hypotheses: the ~1,600 denizens of this community have, 1) more headaches than average, 2) more accessible neurologists per capita than average (~1/1600, formerly 2/1600), or, my favorite, 3) more orgasms than average.

Ample experience shows that cerebral aneurysms can rupture under stress of sexual intercourse. More than just famous people like Nelson Rockefeller have died of brain hemorrhage or heart attack in such circumstances, in what has been called la mort d'amour, a mode of exit even more romantic than a motorcycle accident in Rome.

But the good news is that the vast majority of such headaches, also pompously called "orgasmic cephalgia," "sex headache," and, most unromantically, "headache associated with sexual activity," are indeed benign, more frightening than symptomatic of serious conditions. Though medical science has not found their cause (or the cause of migraine for that matter), experience teaches us several other things: headaches that coincide with orgasm are infrequent, both among populations and even among those unfortunate enough to have had them on occasion. They usually last minutes to hours, occasionally a few days, and are more often reported by people who have had a life-long migraine tendency, especially if it comes with exertion, and by men. They tend to eventually disappear after a small number of appearances.

So, if your headache totally subsides in hours, there is probably little cause for alarm. As headache-free weeks and months pass, the headache is even less likely to be serious.

No systematic trials guide treatment. Not surprisingly, the usual over-the-counter pain remedies rarely help, though claims have been made for most of them. Only if such headaches linger or happen with increasing frequency do you need to call your doctor and anticipate an MRI. Of course, the "worst headache" of your life, under any circumstances, especially if associated with other symptoms like vomiting--or if you are someone for whom headache is a very rare experience--should get you to the Emergency room.


For more information see, Neurology 2003;61;796-800. For a general overview of migraine read Oliver Sacks' Migraine, revised and expanded in 1992. Sacks believes migraine is a "spiritual" condition. He describes the case of an aspiring priest for whom migraine with orgasm seemed to be penance for the indiscretion of his sexual contacts. Note that better migraine treatment, the triptan family of drugs, has been developed since that writing.

A Summer to Love

Hold me, love me

Hold me, love me

I ain't got nothing but love, babe

Eight days a week

So goes one stanza by John Lennon and Paul McCartney that we heard Sunday night when the Matthew Parrish group and Joanna Pascale performed selections from the McCartney Songbook. The concert ended our 40th Anniversary 8-day celebratory week. Love was all around our six concerts that followed the 31st Annual Tour of Gretna Homes, our annual fundraiser that helped make the week possible. 

I can't imagine a more perfect 40th Anniversary celebration. By being excluded from rehearsals I had no idea of the surprise planned for me as an expression of love from the entire Gretna Music family, engineered by Carl and Suzanne: the Mahler Adagietto that opened the concert last Saturday. Mahler sent the manuscript as a love letter to his wife. After that I was too overwhelmed to play many of the notes in the Bach-Stokowski Prelude that followed—I hope few people noticed—but recovered in time for the Serenade, another expression of love by Howard Hanson who wrote it to propose marriage to Peggy. She must have liked it—as most everyone who heard it Saturday said they did. (Insider joke: "That program had Carl Kane written all over it.")

The orchestra and conductor were amazing. All were indeed my family for the duration, enjoying wonderful weather, Gretna ‘charm,’ good food and wine, and hospitality in Gretna and Elizabethtown while rehearsing and practicing up to 8 hours a day under the affable and firm capable direction of Ronny Feldman of the Boston Symphony, Boston Pops, and Tanglewood—and a former mentor of Carl Kane. The joy of hearing our efforts getting better and better in rehearsals made them into play, not work. I have rarely played in such a happy orchestra with such pleasure. New friendships were made and the Gretna Music family adopted new members.

As George Szell said in Cleveland, we started rehearsing at the point where other orchestras finish, with a group that included members of the Philadelphia Orchestra and Momenta and Wister Quartets, and more. For the opening Sunday concert they were joined by Lise de la Salle on her way from the Chicago Symphony to Germany's Moritzburg Festival in a magnificent Jeunehomme Concerto that would have knocked the socks off Mozart. Frank Kowalsky played the Copland Clarinet Concerto in a way that the composer (and dedicatee Benny Goodman) could only have dreamed of. (Frank recalled playing in “The President’s Own” Marine Band with Gretna’s own trombonist Jimmy Erdman!) 

The Philadelphia Orchestra's Assistant Concertmaster, Nancy Bean, and their Principal Cellist, Lloyd Smith, led the orchestra and smaller groups with solid experienced playing. Nancy’s Duo Parisienne with harpist Anne Sullivan played an exquisite program for an onstage audience after a delicious Sunday brunch. The night before Anne played the Mozart Flute and Harp Concerto at the tempos they should be and your humble servant was able to keep up after a lot of practice enabled finally by retirement from his medical career (or perhaps a suspension of normal ennui). We gave Allen Krantz’s new cadenzas a proper sendoff. At the elegant 18th C. Cornwall Inn we played a Haydn Symphony (in a frugal arrangement), a Vivaldi Lute Concerto, Eine Kleine Nachtmusik, and two sexy Piazzolla tangos. Then players and listeners enjoyed wine and dinner.

Veteran musical comedian and PBS and New York Chautauqua regular, Mark Russell, had the Friday audience in stitches for 90 minutes then repaired to a Gretna porch for a late dinner and to regale guests with more stories. 

The dedication of every single musician was inspiring to witness. After weeks of individual preparation and 6-hour rehearsals, their first activity when arriving back at their hosts was to practice for an hour or two. Every one of them is hoping to do it again next summer. With Ronny on the podium.

Gretna Music ‘made budget’ with ticket sales and sponsorships (thanks, Tom Carmany, for sponsoring me). That increased the chances that we can make similar 8-day weeks a feature of future summers.

During those 8 days most Gretna denizens were lounging on their porches or on the decks of the Jigger Shop or HideAway, while the usual hordes of summer visitors ambled around the streets goggling at the cottages or headed for ice cream, mini-golf, or the lake. On rare occasions one or two, by accident passing the open back of the Playhouse, might have turned their eyes from their conversation or the quaint surroundings to peer into the hall. Maybe a few even slightly slowed their pace for an instant. I wondered whether it would have been any different if a reincarnated Mozart had been sitting at the piano or Mahler was conducting.