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.
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.
There are two types of sex headaches. The most common variety:
Gives no warning and occurs within a few seconds of an orgasm
Is often described as throbbing or stabbing
The other variety of sex headache:
Often begins as a dull ache on both sides of the head
May cause tightening of the neck and jaw muscles
Builds gradually over a matter of minutes before an orgasm
Intensifies as sexual excitement increases
Most sex headaches last at least several minutes. Others may linger for a few hours. Many people who have sex headaches will experience them in clusters over a few months and then go for a year or more without having any sex headaches.
When to see a doctor
Sex headaches aren't usually a cause for concern. But consult your doctor right away if you experience a headache during sexual activity — especially if it begins abruptly or it's your first headache of this type.
Any type of sexual activity that leads to orgasm — including masturbation, anal sex, oral sex and intercourse — can trigger sex headaches.
Abrupt-onset and slow-to-build sex headaches can be primary headache disorders not associated with any underlying condition. Sex headaches that come on suddenly are more likely to be associated with:
A widening or bubble in the wall of an artery inside your head (intracranial aneurysm)
An abnormal connection between arteries and veins in the brain (arteriovenous malformation) that bleeds into the spinal fluid-filled space in and around the brain
Bleeding into the wall of an artery leading to the brain (dissection)
Coronary artery disease
Use of some medications, such as birth control pills
Inflammation from certain infections
Sex headaches associated with loss of consciousness, vomiting, stiff neck, other neurologic symptoms and severe pain lasting more than 24 hours are more likely to be due to an underlying cause.
Sex headaches can affect anyone. But risk factors for these headaches include:
Being a man
Being prone to migraine headaches
Sometimes sex headaches can be prevented by stopping sexual activity before orgasm. Taking a more passive role during sex also may help.
You're likely to start by seeing your family doctor or a general practitioner. However, you may be referred to a neurologist. Here's some information to help you get ready for your appointment and to know what to expect from your doctor.
What you can do
Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restricting your diet.
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including past illnesses and operations, major stresses or recent life changes, and any medical problems that run in your family.
Make a list of all medications, vitamins and supplements you're taking.
Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
Write down questions to ask your doctor.
Preparing a list of questions can help you make the most of your time with your doctor. For headaches associated with sexual activity, some questions to ask your doctor include:
What is likely causing my symptoms or condition?
Are there other possible causes for my symptoms or condition?
What tests do I need?
Is my condition likely temporary or chronic?
What is the best course of action?
What are the alternatives to the primary approach you're suggesting?
I have these other health conditions. How can I best manage them together?
Are there any restrictions that I need to comply with?
Should I see a specialist?
Is there a generic alternative to the medicine you're prescribing?
Are there brochures or other printed material I can take? What websites do you recommend?
Don't hesitate to ask other questions, as well.
What to expect from your doctor
Your doctor is likely to ask you questions, such as:
When did you first have a sex headache?
How quickly did your headache begin?
When did the headache begin in relation to orgasm?
Have your headaches been continuous or intermittent?
Were there any symptoms besides pain?
Have you had other types of headaches? If so, what are they like?
Has anyone in your immediate family experienced migraine headaches or headaches associated with sexual activity?
What, if anything, seems to improve your headaches?
Magnetic resonance imaging (MRI). An MRI of the brain can help detect any underlying causes for your headache. During the MRI exam, a magnetic field and radio waves are used to create cross-sectional images of the structures within your brain.
Computerized tomography (CT). In some cases, especially if your headache occurred less than 48 hours beforehand, a CT scan of your brain may be done. CT uses an X-ray unit that rotates around your body and a computer to create cross-sectional images of your brain and head.
Your doctor may also order a cerebral angiogram, a test that can show the neck and brain arteries. It involves threading a thin, flexible tube through a blood vessel, usually starting in the groin, to an artery in your neck. Contrast material is injected into the tube to allow an X-ray machine to create an image of the arteries in your neck and brain.
A less invasive version of this test uses MRI or CT instead of threading a catheter through your blood vessels.
Sometimes a spinal tap (lumbar puncture) is needed as well — especially if the headache started abruptly and very recently and brain imaging is normal. With this procedure, the doctor removes a small amount of the fluid that surrounds your brain and spinal cord. The fluid sample can show if there's bleeding or infection.
In some cases, your first sex headache may also be your only one. Some sex headaches improve rapidly, so the pain is gone before any pain reliever can work. Because of reports that engaging in sex soon after experiencing a sex headache can cause even worse pain, you may be advised to refrain from sexual activity until your last headache has completely resolved.
If you have a history of sex headaches and there's no underlying cause, your doctor may recommend that you take preventive medications regularly. These may include:
Daily medications. Beta blockers, for example, propranolol (Inderal, Innopran XL) — which are used to treat high blood pressure, coronary artery disease and migraines — may be taken daily to prevent sex headaches. They're recommended only if you have frequent or prolonged attacks.
Occasional medications. Indomethacin (Indocin), an anti-inflammatory, or one of the triptans, a class of anti-migraine medications, can be taken an hour before sex to ward off headaches.