Ask Dr. H: He's getting severe headaches after sex

Question: I've recently been getting bad headaches after ejaculation. I've checked my blood pressure and it's good. Would you recommend that I see a neurologist?

Answer: What you're describing sounds like a "benign orgasmic/sex headache." It's due to a swelling of the arteries of the brain - much like what's seen with a migraine headache. It falls under the general category of "exertional headaches." Those who have these headaches are not necessarily migraine sufferers, but often are. In research studies, men seem to be affected four times as often as women.

With intense exercise or the physical activity associated with sex, the muscles of the scalp, head and neck require more blood flow, which can cause headache pain due to blood vessel swelling. The pain is usually sudden, throbbing, and occurs either just before or right after orgasm.

For some, this occurs regularly with sex; but for most sufferers, there's no predicting when it will occur. As a general rule, the more intense the sex, the greater the likelihood that a person predisposed to a sex headache will experience one.

With this said, exertional headaches can be a sign of a serious medical problem known as a subarachnoid hemorrhage from the rupture of a blood vessel in the brain. That's why it's important to have any sudden and new headache event like this one checked out either by your family doctor or a neurologist. An MRI or CT scan of the head is a critical part of that workup.

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Q: Why is the CA-125 blood test not a good screening test for ovarian cancer? I asked my doctor to order the test at my last physical, but he refused.

A: Unfortunately, there are no commercially available screening tests for detecting early ovarian cancer. The only approved use of the CA-125 blood test is in women with known ovarian cancer to monitor treatment response or recurrence. We very much need a test, since only 25 percent of ovarian cancers are found at an early stage. More than half the women diagnosed with ovarian cancer die within five years.

CA-125 is a protein produced in response to irritation of the surfaces of the body cavities. The CA-125 blood test is neither sensitive enough to pick up an early cancer (studies show it can detect early cancer only 20 percent to 57 percent of the time) nor specific enough (it can be falsely elevated because of endometriosis, pelvic infection, uterine fibroids, liver disease, pancreatitis, pneumonia, congestive heart failure and even ovulation) to be clinically useful as a screening test.

Even in advanced ovarian cancer, the CA-125 level has been normal in 20 percent of cases. Some ovarian cancers do not produce any CA-125. More importantly, only half of all ovarian cancers will cause a rise in the CA-125 while the cancer is still contained within the ovary.

For women of high risk, gynecologists may still order a CA-125 test along with a transvaginal ultrasound at the time of their gynecological exam. Always pay attention to persistent vague abdominal symptoms of bloating that have not been explained by irritable bowel syndrome or constipation. If colonoscopy and X-rays don't explain your symptoms, be sure your doctor scans your ovaries and abdomen.