Orgasmic and Preorgasmic Headache - The Basics

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Sometimes, it seems that those of us with migraines and headaches just can't win. Looking at this form of headache can be one of those times. The International Headache Society's International Classification of Headache Disorders, Second Edition (ICHD-II) recognizes a form of headache called primary headache associated with sexual activity. There are two subtypes:

  • preorgasmic headache and
  • orgasmic headache

It's important to distinguish these forms of headache from migraine triggered by sexual activity. These are headaches, not Migraines.

Preorgasmic headache occurs during sexual activity, increasing as sexual excitement increases. It's usually bilateral, a dull ache in the head and neck (not migraine). It can also include neck and jaw muscle tightening.

Orgasmic headache is a severe, sudden headache (not Migraine) that occurs at orgasm.

Both preorgasmic and orgasmic headaches are more common among men than women. Most are short in duration, but for about 15% of those experiencing them, severe pain can last from four hours to 24 hours, which makes treatment necessary.

Primary headache associated with sexual activity has been called by other names in the past:

  • benign sex headache
  • coital cephalalgia
  • benign vascular sexual headache
  • sexual headache

Treatment for this type of headache, when necessary, is usually the NSAID indomethacin. Success rates up to 80% in preventing orgasmic headache have been seen with the beta blocker propranolol.

It is vitally important that other causes be ruled out before assigning a diagnosis of preorgasmic or orgasmic headache. Tests should be performed to rule out causes such as subarachnoid hemorrhage, arterial dissection, and cerebrospinal fluid leaks.

For your reference, here is the ICHD-II information on these two types of headache:

4.4 Primary headache associated with sexual activity

Previously used terms: Benign sex headache, coital cephalalgia, benign vascular sexual headache, sexual headache

Description: Headache precipitated by sexual activity, usually starting as a dull bilateral ache as sexual excitement increases and suddenly becoming intense at orgasm, in the absence of any intracranial disorder.

4.4.1 Preorgasmic headache

Diagnostic criteria:

A. Dull ache in the head and neck associated with awareness of neck and/or jaw muscle contraction and meeting criterion B

B. Occurs during sexual activity and increases with sexual excitement

C. Not attributed to another disorder

4.4.2 Orgasmic headache

Coded elsewhere: Postural headache resembling that of low CSF (cerebrospinal fluid) pressure has been reported to develop after coitus. Such headache should be coded as 7.2.3 Headache attributed to spontaneous (or idiopathic) low CSF pressure because it is due to CSF leakage.

Diagnostic criteria:

A. Sudden severe ("explosive") headache meeting criterion B

B. Occurs at orgasm

C. Not attributed to another disorder1

Note: 1 On first onset of orgasmic headache it is mandatory to exclude conditions such as subarachnoid haemorrhage and arterial dissection.


An association between 4.4 Primary headache associated with sexual activity, 4.3 Primary exertional headache and migraine is reported in approximately 50% of cases.

Two subtypes (dull type and explosive type headache) were included in the first edition of The International Classification of Headache Disorders. No specific investigation has been undertaken since then to clarify whether they are separate entities. In most published reports of headache with sexual activity, only explosive ("vascular type") headache has been reported. The dull type may be a subtype of tension-type headache, but no evidence supports this hypothesis. No firm data are available on the duration of primary headache associated with sexual activity, but it is usually considered to last from 1 minute to 3 hours.

Summary and comments:

Preorgasmic and orgasmic headache, forms of primary headache associated with sexual activity, are more common among men than women. These are headaches, not Migraines, and are generally bilateral. Treatment, when necessary, is usually indomethacin and / or propranolol. When diagnosing, care must be taken to rule out other, possibly more serious conditions.

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Related article:

For information on types of Migraines and headaches, please see:


The International Headache Society. "The International Classification of Headache Disorders, 2nd Edition." (ICHD-II) September, 2004.

Frese, A.; Rahmann, A.; Gregor, N.; Biehl, K.; Husstedt, I-W; Evers, S. "Headahe associated with sexual activity: porognosis and treatment options." Cephalalgia, 2007, 27, 1265-1270

Medical review by John Claude Krusz, PhD, MD

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