Is my headache serious?
January 2, 2011 11:19 AM   Subscribe

Subarachnoid hemmorage, vascular dissection, or just a benign coital headache?

I know YANMD. While engaging in coitus, I got a sudden localized headache in the back of my neck, right at the point where the neck and skull connect. In the instant in which the headache came on, I also felt something in my neck, like a bulge or a pop. The pain was very intense (not the worst headache I have ever had, but I get migraines, so that may skew my judgment of "bad" headaches), and it has continued without abating or increasing for about 14 hours thus far. There are no additional symptoms (e.g., blurred vision, nausea, dilated pupils, loss of motor control, loss of brain functioning). I took Tylenol last night, which normally diminishes my symptoms a little bit, and there was no change whatsoever - my headache neither got better nor worse. How seriously should I take this? Should I go to the ER or can I wait until tomorrow and go to student health?
posted by anonymous to Health & Fitness (10 answers total)
No one on the internet can answer this question for you. If you are worried enough to ask this question, go to the ER. It will if nothing else give you peace of mind.
posted by vincele at 11:25 AM on January 2, 2011 [1 favorite]

I would go to the emergency room or at least an urgent care center, should one be available. Yes, it may be expensive, and you will probably feel stupid if the situation turns out to be nothing, but, as a doctor once said to me "imagine how you would feel if it had been something."
posted by GenjiandProust at 11:43 AM on January 2, 2011

Could it be as simple as a pulled/torn muscle? Is the area at all tender? If you roll your head around, are there angles which hurt, or exacerbate the headache, or are hard to make yourself do?
posted by hattifattener at 11:45 AM on January 2, 2011

I've been in this situation, and I did end up going into the ED of my hospital, just to be safe. I had hit the back of my head on the corner of a wall-mounted plasma TV and had a persistent mild headache for three days afterwards and on day four it became The Worse HA of My Life. Coupled with two episodes of vomiting of unknown etiology, I dragged myself into the adult ED the day before Thanksgiving 2009. In terms of the fact that they also wanted to rule out a hemorrhage in my case, I had a head CT and due to a veteran attending, thankfully avoided the lumbar puncture the intern was excited to get credit for.

In short, although you have a history of migraines, if this HA is presenting differently than your usual migraine and is not improving with usual drug therapies, I think it's a good idea to get it checked out. At the very least, perhaps you can get some relief from the pain from a one-time dose of a different medication. Head pain (and vision changes in particular) are really not something to wait on, in terms of signs/symptoms our bodies are showing us.
posted by Asherah at 11:52 AM on January 2, 2011

This is how my migraines started manifesting--sudden-onset headaches triggered by blood pressure swings. You say you get migraines yourself, so are you being treated for them? Did something like an Imitrex help at all, or did it make no difference? No one here is going to be able to give you a definitive answer as to what you should do, so you should go get this checked out immediately if you've been through your medication regimen and it isn't helping.
posted by Mayor West at 12:24 PM on January 2, 2011

I've had similar "headache following a pop" incidents... it's entirely possible that you're dealing with a muscle or tendon or nerve issue. And the lack of extra symptoms is a pretty damned good thing. However, "spontaneous onset of REALLY BAD HEADACHE" is still worth a trip to your doc or to urgent care, I'd think. IANAD... however, I have recommended "GO TO THE E.R. NOW!" as often as any other Not-a-Doc on MeFi, and I don't think your condition sounds immediately super-alarming. :-)
posted by julthumbscrew at 1:39 PM on January 2, 2011

In my experience that type of headache goes away within an hour. I wouldn't mess with this: go to the doctor right now.
posted by brownrd at 2:10 PM on January 2, 2011

Emergency room, please, if you haven't gone there already. This is a very unusual headache and should be checked out. It is good that you are not having progressive symptoms, but get it checked out anyway.
posted by SLC Mom at 2:25 PM on January 2, 2011

Definitely go to the ER to rule out subarachnoid hemorrhage. But this sounds like coital cephalgia. My wife suffered from it and had it treated with indomethacin.
posted by Jonathan Harford at 2:33 PM on January 2, 2011 [1 favorite]

You might appreciate my friends David and Ashley's recent podcast on diagnosis of subarachnoid hemorrhage from "worst headache" in the emergency department.
posted by nicwolff at 2:43 PM on January 2, 2011

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