A man suffered a massive headache following intercourse. The headache occurred immediately before, through and after orgasm. He immediately went into coma and presented to hospital with a drooping eye and seizures.
Investigations revealed he had suffered a severe subarachnoid haemorrhage (a type of stroke) due to weakness in one of the blood vessels in the brain. The weakness is called an aneurysm and recognised as a cause of death and disability all over the world.
Aneurysms are a small blister on the blood vessels which burst open leading to bleeding into the brain (stroke). It happens and can happen to anyone. Sometimes it also runs in families.
The important fact about this type of stroke is that it occurs suddenly, is often described as the worst headache ever and can lead to disability and death. Patients with stroke can suffer a convulsion and strokes can lead to death if not treated immediately.
Is it Magun?
Magun is a type of traditional medicine or often a curse said to be placed on a woman. This is usually placed on a married woman who strays (infidelity) from the home. It is often said that such a woman or her consort will cry out, have seizures (somersaults) and die due to the effect of the juju. In this regards, the treatment is often to rush the victim to a traditional medicine practitioner to lift the curse or offer remedial therapy to avert death.
Treatment in Nigeria can be delayed if the stroke is labelled as Magun.
Our patient had an aneurysm causing pressure on one of the nerves that move the eyelid hence the droopy eye. He also suffered seizures due to the blood irritating the brain. He underwent an operation to seal off the bleeding aneurysm and recovered completely.
We are not sure whether his sexual partner had Magun placed on her or not.
Sexual headaches
Headache following sexual activity is a well-recognised phenomenon and occurs in countries without access to Nigerian juju men or traditional medicine practitioners. Hence, it is highly likely we are losing patients who could be saved from subarachnoid haemorrhage if they are ‘’diagnosed’’ with Magun.
This type of headache has been given many different names: benign sex headache (BSH), benign coital headache, coital cephalgia, orgasmic cephalgia, primary headache associated with sexual activity (PHSA), coital ‘thunderclap’ headache, primary thunderclap headache (PTH), orgasmic headache (OH) and preorgasmic headache. In 2004, the International Headache Society classified HSA as a distinct form of primary headache.
These benign headaches, precipitated by sexual excitement (masturbation or coitus) occurring in the absence of any intracranial disorder and which can be prevented or eased by ceasing activity before orgasm. There are different types. Type 1 consists of a headache at the back of the head, a pressure-like headache that gradually increases with mounting sexual excitement. Type 2 headaches have an explosive, throbbing quality and appear just before or at the moment of orgasm. These often start at the back of the head and spread all over very rapidly.
Serious business
Headaches and sexual activity are often treated with humour as a typical way for women to reject male advances. However, headaches associated with sexual activity can be anything but a joke.
Sex headaches are brought on by sexual activity — especially an orgasm. You may notice a dull ache in your head and neck that builds up as sexual excitement increases. Or, more commonly, you may experience a sudden, severe headache just before or during orgasm.
Headaches associated with sexual activity can be the same as in serious life threatening cerebral conditions (stroke as described above) and this need to be quickly excluded at the first presentation.
The first time occurs it can be a traumatic, frightening occurrence for the patient. Sexual headaches are unpredictable in nature with poorly understood pathophysiology and uncertain course of the condition. Patients need to have the situation clearly explained to them so that management can be optimal.
Most sex headaches are nothing to worry about. But some can be a sign of something serious, such as problems with the blood vessels that feed your brain. However, occasionally sexual headaches can result from more sinister causes. Intraparenchymal and subdural haemorrhages have been reported as secondary causes of sexual headaches.
So, if you or anyone complains of a severe headache associated with sexual activity, please kindly have it checked out by a qualified medic. A general practitioner, a neurologist or a neurosurgeon is the best person to see: to make a good diagnosis after a thorough investigation.
Good overall management of a patient with this type of headache would also include discussions about possible negative sexual consequences. Sexuality can be affected both during the active condition and subsequently. Sexuality must be addressed by the treating physician if the patient/couple are not to be left with an on-going negative effect on their future sex life as a consequence of the headache.
