Tension headaches made worse by intercourse come on as a dull ache over the whole head, developing before orgasm. It may pulsate in time with the heart beat. The pain of a sub-arachnoid haemorrhage brought on by intercourse is typical of all other sub-arachnoid haemorrhages – a feeling of being hit on the back of the head or neck, followed by an explosive headache of immense severity.
The pain of a true coital headache is a sharp, one-sided, sudden onset, explosive pain which lasts anything from a few minutes to a few hours.
What else could it be?
Because a severe, sudden onset of head or neck pain occurring for the first time at intercourse could be due to a sub-arachnoid haemorrhage you must get medical help immediately. On the other hand, if you’ve already had headaches with intercourse, and this is just another of the series, then it is unlikely to be a subarachnoid haemorrhage.
Headache with intercourse is often due to (or made worse by) tension headache, and, depending upon the sexual techniques used and the position of the neck, it might also be related to previous neck or hack injury, or neck muscle spasm., especially if the head is held in an abnormal position for some time. In particular, bending the head back for any length of time can induce severe neck pain of the muscle spasm variety. The distinguishing features of tension headache, neck injury and neck muscle spasm are that there is often a previous history of injury to the neck, local tenderness of the neck or its muscles, stiffness on bending the neck to the side, and the neck muscles can often be felt in spasm.
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