What should you know about sex headache?

Some headaches build as excitement and exertion increase; others begin abruptly around orgasm. The pain may be at the back of the head, on both sides or throughout the head, and it may settle after activity stops. A headache can also occur with dehydration, heat exhaustion, anxiety, a viral illness or sinus symptoms. These are possible associations, not a diagnosis.

A sudden explosive headache can signal bleeding, a blood-vessel problem or another urgent condition. The first episode, a new pattern, or pain unlike previous headaches should therefore be taken seriously even if it improves.

Stop sexual activity, rest in a cool quiet place and note when the pain began, how quickly it reached its worst point, where it was felt and how long it lasted. Drink fluids if you can do so safely, but do not use hydration as a reason to delay urgent assessment.

For a recurring but previously assessed pattern, a clinician may review triggers, blood pressure, medicines and the need for headache treatment. Do not start preventive medicines or borrow someone else’s prescription.

Call emergency services or attend an emergency department for a thunderclap headache, fainting, confusion, seizure, weakness, numbness, trouble speaking, vision loss, fever with a stiff neck, repeated vomiting or severe pain after injury. Seek prompt medical review for a first sex headache, a headache that keeps returning, or a pattern that is becoming stronger or different.

Ask whether the timing and speed of onset suggest a primary sex headache, whether examination or imaging is needed, which symptoms should bring you back urgently, and how to record future episodes. Tell the clinician about pregnancy, blood-thinning medicines, recent infection and any neurological symptoms.