Brain imaging

Your provider will likely recommend brain imaging.

  • Magnetic resonance imaging (MRI). An Magnetic resonance imaging (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 computed tomography (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.


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.

Preparing for your appointment

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?

May 13, 2022

  1. Starling AJ. Unusual headache disorders. Continuum. 2018; doi: 10.1212/CON.0000000000000636.
  2. Ropper AH, et al. Headache and other craniofacial pains. In: Adams & Victor's Principles of Neurology. 11th ed. McGraw-Hill; 2019. https://accessmedicine.mhmedical.com. Accessed Feb. 13, 2022.
  3. Jameson JL, et al., eds. Migraine and other primary headache disorders. In: Harrison's Principles of Internal Medicine. 20th ed. McGraw-Hill; 2018. https://accessmedicine.mhmedical.com. Accessed Feb. 20, 2022.
  4. Cutrer FM. Primary headache associated with sexual activity. https://www.uptodate.com/contents/search. Accessed Feb. 13, 2022.
  5. Headache: Hope through research. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Headache-Hope-Through-Research. Accessed Feb. 13, 2022.
  6. Scíslickí P, et al. Headache associated with sexual activity — A narrative review of the literature. Medicine. 2021; doi:10.3390/medicina57080735.
  7. Makarevičius G, et al. Successful treatment of primary headache associated with sexual activity using erenumab: Case report. Cephelagia. 2022; doi:10.1177/03331024221075074.


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