A recent study published in the Journal of Chiropractic Medicine has taken on a type of headache thought to affect only 1-1.6% of the population. Rare though it may be, Primary Headache Associated with Sexual Activity (PHASA) is recognised by the International Classification of Headache Disorders and remains poorly understood. There are a few pharmacological interventions that have been suggested for the management of PHASA. In the recent case study, however, the 19-year-old female patient presented at a chiropractic clinic for care after pharmaceutical interventions had yielded little or no relief.

The headline could indeed because for a giggle, but in this particular case, the patient was left with an intense left-sided headache that could last for up to 72 hours. The onset of the headache occurred right before or during orgasm and rated at a 9/10 on the pain scale, reaching its peak in the first couple of minutes before reducing to a 6/10 until the headache eventually resolved. The intensity of the pain, the situations in which it occurred, and the days-long length of the headache could foreseeably have a far-reaching effect on quality of life.

The specific cause or contributing factors to the development of PHASA is not well understood. Previously, these headaches have been divided into two subcategories; pre-orgasmic and orgasmic. The study’s authors noted the definitions of these as:

  • “Pre-orgasmic: classically described as a dull, usually occipital pressure pain that appears during sexual activity and increases with mounting sexual excitement [1].”
  • “Orgasmic: classically described as a sudden explosive headache followed by severe throbbing head pain that occurs just prior to or at the moment of orgasm [1].” 

While recent clinical studies have failed to distinguish these particular headaches from other headache types, “PHASA” is now the accepted term for the phenomenon, which can vary in its presentation from patient to patient [3]. These headaches can be experienced in any sexually active stage and are more common in men than women with some epidemiological study reporting a 3:1 ratio [2].

We know that PHASA headaches seem to have any number of these characteristics [4]:

  • A dull headache, predominantly bilateral.
  • Mostly diffuse (all over the head) or occipital (behind the eyes).
  • Usually builds as an individual gets closer to orgasm.
  • Can be very sharp and intense either immediately prior to or during orgasm.
  • Pain duration can vary from 1 minute to 72 hours

In the specific case study involving the 19-year-old female, there were no significant medical events in her history, and no history of intense headaches prior to suffering from PHASA. At the time of presentation, her headaches almost always lasted from 48-72 hours. The only medications she took were contraceptives and ibuprofen for pain. However, she noted that she experienced no significant relief from her pain. She was diagnosed as suffering from PHASA by a neurologist with extensive experience in headaches.

Upon presenting to a chiropractor, she had suffered from the condition for six months. Her attending chiropractor used the Gonstead method and saw her for a total of nine visits over three months. (The case report notes that the 6th and 7thvisits were about unrelated complaints). The chiropractor took a baseline evaluation, and then 3, 6 and 12-month follow-ups to ascertain her status post-care.

At the three-month point, her headaches had ceased (decreased from being affected every day of the prior month) and she was no longer using pharmaceutical pain relief.  At the six-month evaluation, she reported being affected by headaches for ten days out of the month, but at a greatly reduced intensity of 0.5 out of ten, and for less than 2 minutes, resolving without ibuprofen.

At the 12-month mark, she was free of symptoms (which came with no reduction in sexual activity after the first three weeks of treatment).

The resolution of this condition suggests that there might have been underlying conditions that were addressed during the course of spinal manipulation. However, this is only speculation. It does prove interesting though, as there is existing data around spinal manipulation (and chiropractic more specifically) being helpful for headaches. Still, more research is required to delve into the mechanics of how and why this particular type of headache may respond well to chiropractic care.

As with all case reports, we cannot generalise based on one case alone. But it would certainly prove an interesting area for further research.



  1. Primary headache associated with sexual activity (Orgasmic headache). American Migraine Foundation. 2018.
  2. Hartmut Gobel. 4.3 Primary headache associated with sexual activity – ICHD-3 The International Classification of Headache Disorders 3rd edition. ICHD-3 The International Classification of Headache Disorders 3rd edition. 2018.
  3. Frese A, Eikermann A, Frese K, Schwaag S, Husstedt I-W, Evers S. Headache associated with sexual activity: Demography, clinical features, and comorbidity. Neurology. 2003 Sep 22;61(6):796–800.
  4. ‌Nascimento B, Mulhall JP. Sexual Headache. The Journal of Sexual Medicine. 2018 Dec;15(12):1663–6.
  5. Sommerseth O, Chaibi A. Remission of Primary Headache Associated With Sexual Activity in a Woman After Chiropractic Spinal Manipulation: A Case Study. Journal of Chiropractic Medicine. 2020 Aug.
  6. Headache associated with sexual activity: demography, clinical features, and comorbidity. Frese A, Eikermann A, Frese K, Schwaag S, Husstedt IW, Evers S Neurology. 2003 Sep 23; 61(6):796-800.


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