Headache Associated with Sexual Activity (HAWSA) is a rare condition seen in one to two percent of the population.
At a neurologist’s office in Hyderabad, a 44-year-old woman presented with a unique problem. Despite enjoying sexual intercourse with her husband, she experienced severe headaches immediately after having an orgasm. These headaches were not only intense, but also significantly impacted her quality of life.
After listening to the history of the patient, neurologist Dr Sudhir Kumar at Apollo Hospitals, Hyderabad, diagnosed her with Headache Associated with Sexual Activity (HAWSA).
Speaking to South First, Dr Sudhir Kumar explains, “Headaches during sexual intercourse or after an orgasm can affect one to two percent of the population (both men and women). However, there are treatment options available for this.”
For 44-year-old Anubha (name changed), sexual activity with her husband, though enjoyable, would turn extremely painful as she would end up with severe headache. Her headaches were located at the back of the head, were throbbing in nature, and started soon after she experienced orgasm.
Dr Sudhir Kumar explains that the patient told him that each headache episode would last for 30-60 minutes duration with no nausea or vomiting. Interestingly, Anubha did not have any history of migraine.
Woman who experienced severe headaches related to orgasm
44-year old Mrs Anubha (name changed) consulted along with her husband with an unusual complaint- severe headache that started immediately after orgasm. She enjoyed having sexual intercourse with her husband, however, the…
— Dr Sudhir Kumar MD DM (@hyderabaddoctor) December 7, 2023
Her husband told the doctor that he initially thought that this could be a psychological problem as this was a second marriage for both of them. The duo had lost their respective partners. Anubha and Ravi (name changed) were married for six months.
“On detailed querying by her husband, Anubha denied any psychological symptoms or unhappiness in the marriage. She apparently expressed her deep love and insisted that she did not have any problems with their sexual life as well,” Dr Sudhir Kumar recalls.
Later, the couple thought that this could be a neurological issue and decided to consult the doctor in Hyderabad.
Interestingly, the doctor who listened to the patient’s complaint, immediately diagnosed this condition as HAWSA, which, though rare, is not uncommon.
It is seen in one to two percent of the population where diagnosis criteria for HAWSA includes at least two episodes of pain in the head and/or neck during or after sexual activity.
The other diagnostic criteria is pain in the head that increases in intensity with increasing sexual arousal, and/or it has abrupt explosive intensity just before or with an orgasm, explains the doctor.
He says that the pain might last from one minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity. Further, the pain cannot be better accounted for by any other diagnosis.
After counselling the couple, the doctor informed them that they need not suffer and that there are effective medical treatments available for this.
However, Dr Sudhir Kumar tells South First, “People should meet the diagnosis criteria before declaring that they have HAWSA. Also, those who experience a first episode of headache after sexual activity may need a brain scan to exclude other causes of headaches.”
The couple has now been started on preventive medication to prevent headaches related to sexual activity.
Interestingly, there is literature and several studies that have linked orgasms and headaches. Often termed as “sex headaches”, studies say that these can manifest in various ways and are influenced by several factors.
According to a study by researchers in Poland, there are primarily three types of sex headaches: One is a dull ache in the head and neck that intensifies with sexual excitement, the other is an “explosive type” — a sudden, severe, throbbing headache that occurs just before or at the moment of orgasm. In some cases, individuals may experience a combination of both types.
The third type is “postural type”, which is a positional headache developing after sexual activity with clinical features consistent with low cerebrospinal fluid pressure headache that can caused by intense sexual intercourse.
The study found that these headaches usually last for several minutes, but in some cases, they may persist for hours or even days. Many people experience these headaches in clusters over a few months, followed by long periods without any episodes.
The study concluded that sex headaches are generally not a cause for concern. However, in rare cases, they can be indicative of more serious issues, such as problems with the blood vessels that feed the brain, including intracranial aneurysms or arteriovenous malformations.
Therefore, it is advisable to consult a healthcare provider, especially if the headache begins abruptly or if it’s the first headache of this type experienced during sexual activity.
Dr Sudhir Kumar says that this is not the first case of HAWSA he has seen. He has been following the cases of two other patients with symptoms similar like Anubha.
While one is a 24-year-old single woman who witnesses similar headaches after orgasm and during sexual intercourse with her boyfriend, the other is a 30-year-old single man who gets headaches after masturbation.
“While the woman is on prophylactic medicines and is doing well, the man has been asked to reduce masturbation frequency and has been recommended pain-relief medicines on an SOS basis,” Dr Sudhir explains.
Doctors say that people with a history of migraines are more prone to experiencing sex headaches. Moreover, the most severe sex headaches seem to occur more frequently in individuals with chronic migraines or a history of migraines. This suggests a possible link between migraines and the mechanism behind sex headaches.
Speaking to South First, Dr Venkataramana N, Chairman and neurologist at Brains Super Speciality Hospital in Bengaluru, said, “Though there have been a few such cases, many of them tend to take a painkiller post sexual activity and several times do not relate the two. They may not even know that this is a sex headache and could be treated, if diagnosed.”
Doctors say that it’s essential for individuals experiencing severe headaches during or after sexual activity to seek medical attention promptly to rule out any serious underlying causes.