Sex headaches, also known as orgasmic headaches, are sudden, severe headaches that occur during sexual activity, typically at the moment of orgasm. These headaches are usually benign and can be classified as either primary or secondary.

Primary sex headaches are usually harmless and occur spontaneously, often in people who are prone to migraines. They typically last from several minutes to several hours and can be throbbing, bilateral (affecting both sides of the head), and severe.

Secondary sex headaches, on the other hand, can be a symptom of an underlying medical condition, such as bleeding in the brain, an aneurysm, or a tumor. These headaches are usually more severe and persistent than primary sex headaches and require immediate medical attention.

If you experience sex headaches, it is important to see a healthcare provider to rule out any underlying medical conditions. Treatment options for primary sex headaches may include taking over-the-counter pain relievers or prescription medications, such as indomethacin or propranolol, which can help prevent the headaches from occurring. In some cases, avoiding sexual activity or using preventative medication may be necessary. If the headaches are caused by an underlying medical condition, treatment will depend on the specific condition and may include surgery or other medical interventions.

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 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)
• 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.

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

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.
• Occasional medications. Indomethacin (Indocin, Tivorbex), an anti-inflammatory, or one of the triptans, a class of anti-migraine medications, can be taken an hour before sex to prevent headaches.