Yes! Yes! OH NO!

Dear Pharmacist,

I get headaches during sex. It's not all the time, but I'm worried. It takes the fun out of it. My doctor said don't worry. But I do.

--E.L., Dunnellon, Florida

Answer:Orgasmic headaches or plain old "sex headaches" affect about 1 in 100 people. The pain often begins at the base of the brain and radiates to the front of your head at any point. It can happen any time during lovemaking. Most people get a sudden, sharp headache right at the Big O, as in orgasm. Yes! Yes! OH NO! The headache comes on suddenly and it's severe. I suspect migraineurs and clusterheads are more prone to these, although sex headaches have no aura, stars, blurriness, no halo, nothing... and they're short-lived. If it's "postural" the pain will reoccur as soon as you get out of bed and stand up but then it goes away quickly. Lots of you have sworn off sex.

These headaches don't always happen to people who "get lucky," they can also be brought on by exercise, coughing or exertion. Scary. You probably think you burst an aneurysm! Fortunately, it's just a headache, but do all the tests and brain scans your physician orders okay?!

A Russian study evaluated 19 participants who suffered from sex headaches. The researchers discovered that 58% developed headaches during foreplay but before orgasm, and 26% of them developed the headaches during orgasm. Some participants developed their headache post-orgasm. Most headaches lasted for several minutes., although one unlucky person's did linger for 24 hours! The researchers suspect that sex headaches are caused from a "disturbance of venous outflow and dysfunction of antinociceptive systems." Essentially, something is amiss with your blood vessel around your brain and your pain perception. Experts also wonder if it happens from an increase in blood (arterial) pressure combined with tension from big event.

That makes sense to my good friend, Douglas Hall, MD, who has four decades experience in obstetrics and gynecology. He says, "Endothelial dysfunction with low nitric oxide (NO) can cause vasoconstriction with resulting headaches. You can check NO levels with urine testing strips. NO is stimulated by estrogen and thyroid so you might have to increase these hormones to a physiologically normal level in order to prevent the headaches."

Other ways to relieve these include the following (ask your doctor):

• Take an anti-inflammatory about 1 hour before the big event, such as 500mg acetaminophen or 400mg ibuprofen.
• Don't be so active during sex, take it easier if you know what I mean.
• Maybe race a little faster to the finish line? If you linger for an hour to get there, your blood pressure remains higher, for longer.
• Prescribed beta blockers (propanolol) are sometimes used, but not with great success. Foods with natural beta blocking activity include bananas, potatoes, raisins, beans, celery, citrus, spinach and chamomile.
• Progesterone. It's the pregnancy hormone, but you should only apply this cream, or take pills if you are low.