From the Guidelines
Post-coital headaches can be effectively managed with a combination of preventive and abortive treatments, including NSAIDs, triptans, and lifestyle modifications, with the goal of reducing morbidity, mortality, and improving quality of life.
Management Options
- For prevention, taking indomethacin (25-50mg) or propranolol (20-40mg) 30-60 minutes before sexual activity can be effective, as suggested by general medical knowledge.
- For acute treatment once the headache begins, NSAIDs such as ibuprofen (400-800mg) or naproxen (500mg) can provide relief, as supported by the American College of Physicians guideline 1.
- In severe cases, oxygen therapy or triptans may help abort the headache.
- Lifestyle modifications are also important, including:
- Staying well-hydrated
- Avoiding alcohol before sex
- Considering a more passive sexual role temporarily
Important Considerations
- If headaches persist or are particularly severe, patients should seek medical evaluation to rule out serious underlying conditions like subarachnoid hemorrhage or arterial dissection.
- Most post-coital headaches are benign and related to exertion-induced changes in blood pressure and muscle tension during sexual activity.
- They typically resolve within minutes to hours but can recur in episodes lasting weeks to months before spontaneously remitting.
Pharmacologic Treatments
- The choice of a specific NSAID or triptan should be based on individualized decision making, taking into consideration patient preferences on such factors as route of administration and cost, as recommended by the American College of Physicians guideline 1.
- Consider treating mild episodic migraine headache with an NSAID, acetaminophen, or the combination of an NSAID and acetaminophen, as suggested by the guideline 1.
- Although available comparative effectiveness data were uncertain, there is evidence supporting efficacy for CGRP antagonists-gepants (rimegepant, ubrogepant, or zavegepant) or ergot alkaloid (dihydroergotamine) for moderate to severe acute episodic migraine headache, as noted in the guideline 1.
From the Research
Management Options for Post Coital Headaches
There are no specific studies provided that directly address the management of post coital headaches. However, the management of headaches in general can be applied to post coital headaches.
General Management of Headaches
- The first step in managing headaches is to determine whether the headache is primary or secondary 2.
- Primary headaches can be managed with acute treatments such as acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine 3.
- Patients not responsive to these treatments may require migraine-specific treatments including triptans, gepants, and lasmiditan 3.
- Preventive treatments include antihypertensives, antiepileptics, antidepressants, calcitonin gene-related peptide monoclonal antibodies, and onabotulinumtoxinA 3.
- Behavioral strategies are also important and should be part of any comprehensive headache management plan 4.
Importance of Diagnosis
- A careful history and physical examination are essential in diagnosing headache disorders 2, 5.
- Imaging is generally not warranted unless there are red flags or warning symptoms of a secondary headache disorder 4, 5.
- The approach to the patient with headache requires knowledge of the diagnostic criteria for primary headache disorders and recognition of the importance of a systematic evaluation for red flags associated with secondary headache disorders 5.