Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Pressure In The Neck During Intercourse?
Question: On Saturday I experienced extreme pain and pressure in my neck and base of my skull when reaching sexual orgasim during missionary sex with my wife. I immediately lost erection and experienced a near nauseating headache for several hours with milder pain emminating from the same area. I experience these same symptoms again the next day when sexually engaged with my wife.
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Headache associated with sexual activity is not rare. It affects about 1% of the population, mostly men.
In the majority of the cases it is benign, related to facial and neck muscles. However there are some rare instances, especially when the onset is very abrupt when it may be in the setting of a more serious issue such as a subarachnoid hemorrhage or other types of stroke. For that reason in such cases an evaluation in the ER is advised for neurological symptoms and there is such a suspicion confirmed brain imaging, possibly with MRI is advised. A CT scan is also of value if a MRI is not available on an emergent basis where you live.
If imaging excludes such issues then as I said it is benign. To prevent it the use of Indomethacin before sexual activity (25-100 mg) or Propranolol are the most commonly used options.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Headache associated with sexual activity is not rare. It affects about 1% of the population, mostly men.
In the majority of the cases it is benign, related to facial and neck muscles. However there are some rare instances, especially when the onset is very abrupt when it may be in the setting of a more serious issue such as a subarachnoid hemorrhage or other types of stroke. For that reason in such cases an evaluation in the ER is advised for neurological symptoms and there is such a suspicion confirmed brain imaging, possibly with MRI is advised. A CT scan is also of value if a MRI is not available on an emergent basis where you live.
If imaging excludes such issues then as I said it is benign. To prevent it the use of Indomethacin before sexual activity (25-100 mg) or Propranolol are the most commonly used options.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I feel ok right now, but started feeling less severe symptoms again today when I elevated my heart rate to 150 while using the stair climber at the gym this afternoon. Once my heart rate lowered the pressure at the base of my skull decreased and eventually went away. I am 64 years old and in relatively good but slightly overweight at 183 lbs. I'm sensitive to a potential SAH since this is what killed my father at age 58. Should I see my GP, a nuerologist or go to the ER? As I stated, I feel normal right now, but I am concerned.
What I meant to ask - is it possible for me to be now asymptomatic and still have suffered a SAH or still be in danger of suffering a SAH?
What I meant to ask - is it possible for me to be now asymptomatic and still have suffered a SAH or still be in danger of suffering a SAH?
Brief Answer:
Read below.
Detailed Answer:
Whether you should see a neurologist depends on whether one is available, if you need to take a distant appointment then there is no sense in waiting for that. I would start with the ER since there is I suppose the possibility to be seen the earliest. That is because if suspected by the physical exam a subarachnoid hemorrhage is more likely to be detected on imaging in the first few days, the earlier the better.
As for whether it is possible to be asymptomatic now, yes it is possible. There are cases when there is only a small leak which doesn't increase intracranial pressure and headache can improve spontaneously very quickly.
I do not want to scare you, most cases are benign, but it is the very abrupt onset which you described which makes me recommend to be checked to put your mind at rest.
Let me know if I can further assist you.
Read below.
Detailed Answer:
Whether you should see a neurologist depends on whether one is available, if you need to take a distant appointment then there is no sense in waiting for that. I would start with the ER since there is I suppose the possibility to be seen the earliest. That is because if suspected by the physical exam a subarachnoid hemorrhage is more likely to be detected on imaging in the first few days, the earlier the better.
As for whether it is possible to be asymptomatic now, yes it is possible. There are cases when there is only a small leak which doesn't increase intracranial pressure and headache can improve spontaneously very quickly.
I do not want to scare you, most cases are benign, but it is the very abrupt onset which you described which makes me recommend to be checked to put your mind at rest.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I m not an alarmist but do believe I have suffered a SAH based on my father's medical history. Physically, I resemble my father in many ways and believe his SAH was a result of an undetected congenital condition. I live in the XXXXXXX Bay Florida area and have very good health insurance coverage so access to good medical care is not an issue. My delima is we are approaching Thanksgiving holiday and I'm inclined to wait to seek evaluation until Monday 11/28 which would be eight days since symptoms last occurred. Will waiting that long contribute to a possible missed diagnosis? I would not ask this if not for the fact I do not presently feel any symptoms which makes me feel hesitant about seeking treatment at a hospital ER.
As you can possibly imagine, presenting myself to an ER stating I believe I've had a SAH is a reluctant thing to do especially on Thanksgiving weekend. Please advise best course of action.
As you can possibly imagine, presenting myself to an ER stating I believe I've had a SAH is a reluctant thing to do especially on Thanksgiving weekend. Please advise best course of action.
Brief Answer:
Read below.
Detailed Answer:
I do not see anything wrong with going to the ER really. Of course not say the SAH diagnosis (I admit us doctors do not like that), but simply say that you had an abrupt onset of the worst headache you have ever had. It's what happened and is a completely justified cause for evaluation, nothing wrong with that.
As for a missed diagnosis..... to make the diagnosis there is first imaging through CT or MRI. MRI has a high sensitivity for many days, but generally is not available in the ER. The CT which is the usually available exam has a very high sensitivity in the first day over 95%, but afterwards declines to 80% after 3 days and detects only about 50% after a week. Since it would be a small leak (if there is one that is) that percentage would be even lower for you. So for detecting it with CT the sooner the better.
Afterwards when doctors feel by the history that even if imaging is normal there is a high likelihood of a SAH then there is the lumbar puncture. It maintains a very high sensitivity in the first 3 weeks so it wouldn't be missed, but as I patient I would prefer have it seen on imaging and avoid an unpleasant procedure such as the lumbar puncture when possible.
There is also the risk of the rebleed which is the main issue, it is higher in the first month especially first days days after a SAH, so if one decides to pursue things, again, the sooner the better.
I hope to have been of help.
Read below.
Detailed Answer:
I do not see anything wrong with going to the ER really. Of course not say the SAH diagnosis (I admit us doctors do not like that), but simply say that you had an abrupt onset of the worst headache you have ever had. It's what happened and is a completely justified cause for evaluation, nothing wrong with that.
As for a missed diagnosis..... to make the diagnosis there is first imaging through CT or MRI. MRI has a high sensitivity for many days, but generally is not available in the ER. The CT which is the usually available exam has a very high sensitivity in the first day over 95%, but afterwards declines to 80% after 3 days and detects only about 50% after a week. Since it would be a small leak (if there is one that is) that percentage would be even lower for you. So for detecting it with CT the sooner the better.
Afterwards when doctors feel by the history that even if imaging is normal there is a high likelihood of a SAH then there is the lumbar puncture. It maintains a very high sensitivity in the first 3 weeks so it wouldn't be missed, but as I patient I would prefer have it seen on imaging and avoid an unpleasant procedure such as the lumbar puncture when possible.
There is also the risk of the rebleed which is the main issue, it is higher in the first month especially first days days after a SAH, so if one decides to pursue things, again, the sooner the better.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
