In rare instances, headaches can be brought on by sexual activity — especially with orgasm. You may notice a dull ache in the 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 the brain.

There are two types of sex headaches:

• A dull ache in the head and neck that intensifies as sexual excitement increases
• A sudden, severe, throbbing headache that occurs just before or at the moment of orgasm

In some people, both types of headaches are combined.

Most sex headaches last at least several minutes. Others may linger for hours or even 2 to 3 days.

Many people who have sex headaches will experience them in clusters over a few months, and then they may go for a year or more without having any. Up to half of all people with sex headaches experience them over the course of about six months. Some people may only have one attack during their lives.

Sex headaches aren't usually a cause for concern. But consult your health care provider 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 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 irregular 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)
• Narrowing of the arteries in the brain (reversible cerebral vasoconstriction syndrome)
• Stroke
• 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 neurological 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 male. Men are more prone to having sex headaches.
• History of migraines. Being prone to migraines increases your risk of sex headaches.

Sometimes sex headaches can be prevented by stopping sexual activity before orgasm. Taking a more passive role during sex also may help.

Brain imaging

Your provider will likely recommend brain imaging.

• 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 the brain.

• Computerized tomography (CT). In some cases, especially if your headache occurred less than 48 to 72 hours beforehand, a CT scan of the brain may be done.

  CT uses an X-ray unit that rotates around the body and a computer to create cross-sectional images of the brain and head.

• Magnetic resonance angiography (MRA) and computerized tomography (CT) angiography. These tests visualize the blood vessels leading to and inside the brain and neck.

Angiograms

Your provider may also order a cerebral angiogram, a test that can show the neck and brain arteries.

This procedure involves threading a thin, flexible tube through a blood vessel, usually starting in the groin, to an artery in the neck. Contrast material is injected into the tube to allow an X-ray machine to create an image of the arteries in the neck and brain.

Spinal tap

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 provider removes a small amount of the fluid that surrounds the brain and spinal cord. The fluid sample can show if there's bleeding or an 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.

Preventive medications

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) or metoprolol (Lopressor, Toprol-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. A calcium channel blocker, such as verapamil hydrochloride (Calan SR) — which is also used to treat high blood pressure — may be an option. In people who have a history of migraine, other migraine preventive medications may be used.
• Occasional medications. Indomethacin, an anti-inflammatory, or one of the triptans, a class of anti-migraine medications, can be taken an hour before sex to prevent headaches.

You're likely to start by seeing your provider. 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 provider.

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 provider.

Preparing a list of questions can help you make the most of your time with your provider. For headaches associated with sexual activity, some questions to ask your provider 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 that may come up during your appointment.

What to expect from your doctor

Your provider 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 migraines or headaches associated with sexual activity?
• What, if anything, seems to improve your headaches?
• What, if anything, makes your headaches worse?