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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Saturday, July 11, 2009

    Not Tonight, Dear...

    Recently I got an email from a patient noting that he had been getting really severe headaches during sexual intercourse. Naturally, he was concerned about this and was wondering what might be causing it. This is a well known phenomenon in neurology sometimes called benign explosive sexual headache. It's more common in men than in women. I can state that I have seen several patients who had this problem and they all were male. (This is called anecdotal evidence.)

    Most episodes of this type of headache are, as the name suggests, benign and can be controlled with medication. It seems to be more common in people with a prior history of migraine. In a few cases it can be an early sign of brain aneurysm but this really is not common; when I see someone with this complaint it is not my first impulse to get a brain MRI. It's a good idea to get a family history of aneurysm or polycystic kidney disease, though.

    If medication is required, your best bet is a beta blocker. (Which, in its turn, may induce erectile dysfunction, but we can't have everything.) Another option would be taking a pain medication, such as ibuprofen, before intercourse. Once the headache starts, taking meds doesn't seem to do much good. You just have to wait for the headache to wear off.




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