On several occasions I have developed a severe headache immediately after orgasm. Should I be worried?

When sex is a headache

On several occasions I have developed a severe headache immediately after orgasm. Should I be worried?

There is a medical term for this type of headache – benign coital headache or benign sexual headache. In the vast majority of cases, a headache that occurs around the time of orgasm is not at all serious, although it can be very painful and frightening. Both men and women can experience this type of headache, sometimes described by neurologists as an unusual form of migraine. The typical story is of a severe headache that develops just before or after orgasm. The pain is often at the back of the head, but it can be at the side. Usually, but not always, it affects both sides of the head. The severe headache lasts for up to 15 minutes, although some people say that it can go on as a dull headache for many hours. People who have benign coital headache find that they may get several attacks in succession, and then none for a long time. About 50 percent of people with this type of headache get one or two attacks and the problem then goes away spontaneously. There is a remote possibility that headaches associated with sexual activity could be associated with something more serious, such as a malformation of blood vessels within the brain. If you get nausea or vomiting, or if your vision is affected in any way, you should see a doctor urgently. If the headaches persist, there are some drugs that can be used to prevent them. The most common is a beta-blocker called propranolol.

Why won't it go?

I am 35, and for the last three years (following a nasty chest infection) I have had a persistent irritating cough in the mornings, lasting about half an hour. X-rays and a lung-function test showed my lungs are fine. My doctor thinks I have asthma, although I have no difficulty breathing, but occasionally I sound a bit wheezy. Any suggestions?

A chest infection is often the trigger for asthma-like symptoms, even in people who have never had asthma before. I assume you aren't a smoker. If you are, that may explain your morning cough. But if you don't smoke, the infection could have made your bronchial tree hyper-irritable. When the lungs are in this state they have a tendency to go into a coughing bout with little or no stimulus; simply getting out of bed can be enough. As your lung-function tests and X-rays are normal, you can feel confident that there is no serious illness lurking. This type of problem can sometimes be solved by using either a steroid inhaler (Becotide, Flixotide or similar) or a long-acting reliever inhaler (Serevent) for a few months. These inhalers damp down the inflammation within the lungs and make the bronchial tree less irritable. As a last resort, I would even try a short sharp course of steroid tablets.

Malaria mix-up

My wife and I are going to Thailand and we have received conflicting advice on what we should take to prevent malaria. We are spending most of our time in Bangkok, but for a few days we are travelling to the coastal resort of Phuket, and then on to a remote area near the Cambodian border. My wife has been told that malaria tablets are not necessary. I have been told to take a new treatment called Malarone.

Malaria is transmitted by mosquito bites. The risk of catching it depends on whether or not you are bitten by mosquitoes, and whether or not the mosquitoes that bite you are carrying the disease. In Bangkok and Phuket there is a very low risk of catching malaria, and for these areas it is not necessary to take antimalarial tablets. Near the Cambodian border, however, the risk of catching malaria is much higher. The mosquitoes in this area carry a form of malaria that is resistant to some standard drugs. You and your wife have been given conflicting advice because there is no single correct answer to the question. The most important thing is to try to prevent mosquito bites. You should sleep under insecticide-treated mosquito nets and use an insect-repellent that contains DEET. For a short visit of a few days, this may be the most sensible thing to do. Even the best antimalarial tablets are not 100 per cent effective. Whether or not you choose to take antimalarial tablets, the most important thing is to see a doctor urgently if you become unwell or develop a fever for up to a year after your trip.

Malaria is usually quite easy to treat, but only if you tell the doctor that you have been travelling in a malaria area. The website www.cdc.gov/travel is an excellent source of general advice on travellers' health problems.

Have your say

Several readers have made suggestions about early-morning joint stiffness:

ML says: I had a similar problem five years ago. I stopped drinking orange juice and the stiffness disappeared. It only returns if I consume citrus fruit.

JH, a registered homeopath, says: The homeopathic medicine Rhus Tox is wonderful for treating stiffness that is worse on first motion and better with continued motion. A suggested dose would be one pill four times daily for four weeks.

Please send questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182 or e-mail health@independent.co.uk. Dr Kavalier regrets he is unable to respond personally to questions