Sexual headache is a headache that occurs during sexual activity. The headache may begin as a dull ache during sex, peak during orgasm and abate after sexual activity has stopped. It is described as aching in character beginning in the occipital area. Sexual headache may also occur quickly around the time of orgasm. This type of pain is severe, occipital and may remain for several minutes after orgasm. Some patients report residual pain for several days afterwards. Although some studies do not show a gender predilection, others report that males are more likely to be affected by sexual headache. Some studies also show the patients with migraine disorder are more likely to have this type of headache. Patients who use medications for erectile dysfunction ( Viagra, Cialis, Levitra) can have headaches secondary to the use of these medications. This type of headache is not a sexual headache. Sexual headache should be distinguished from other causes of headaches with similar symptoms such as migraine, trigeminal neuralgia, cluster headache and chronic paroxysmal hemicrania. Any neurological abnormality should be investigated and is a sign of an underlying disease. MRI and CT scans of the brain can be useful to look for intracranial abnormalities such as tumor or aneurysms. Screening blood work is useful to look for infection or autoimmune diseases. Intraocular pressure should be tested to excluded glaucoma as a cause of headache. Treatment of sexual headache is with medications. Beta-blockers can be tried as a prophylactic treatment and titrated upward in dose to effect. Indomethacin, a non-steroidal anti-inflammatory, can be useful as well.