Hi, Sex headaches are brought on by sexual activity like an orgasm. You may notice a dull ache in your head and neck that builds up as sexual excitement increases. There can also be a sudden, severe headache just before or during orgasm as mentioned by you. Most sex headaches are nothing to worry about. But some can be a sign of something serious, such as problems with the blood vessels that feed your brain. It is important to keep a record of how often you get such headaches. Such headaches can be precipitated by the following conditions A widening or bubble in the wall of an artery inside your head (intracranial aneurysm) 1. 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 2. Bleeding into the wall of an artery leading to the brain (dissection) 3. Stroke 4. Coronary artery disease 5. Use of some medications, such as birth control pills 6. Inflammation from certain infections Sex headaches associated with loss of consciousness, vomiting, stiff neck, other neurologic symptoms and severe pain lasting more than 24 hours are more likely to be due to an underlying cause. It is advised that you consult a neurologist and get possible serious causes ruled out.