Concept: A rare primary headache that occurs during sexual activity. Clinical features: It can occur at different ages and in both sexes. The headache may be bilateral or unilateral and may occur in any location. It can last from a few minutes to several hours. The headache may be stabbing, dull, tight, knife-like, lightning-like, shock-like, or thunderclap pain. The literature reports that about 60% of headaches are sex-related and 40% of headaches can be combined with sex-unrelated headaches. According to the mechanism, there are three types of headache: Type1: Occurs before orgasm (during sexual excitement). It is related to the strong contraction of cervical, cranial and facial muscles. The headache mostly occurs in the occipital region. Some patients have a history of tension headache. Some patients have a history of tension headache. The headache is relieved after sexual activity is aborted or after ejaculation, or partially relieved when passive position is adopted. Type2: Occurs during orgasm. Associated with altered hemodynamics. Headache may occur in the temporal/occipital region. Most often accompanied by increased blood pressure, increased heart rate, vascular pulsation in the ear, flushing, vomiting, numbness, confusion, and visual field defects. Some patients have a history of migraine. To be differentiated are: subarachnoid hemorrhage due to aneurysm; primary aortitis, etc. Type3: Rare. May be related to hypocranial pressure caused by extravasation of cerebrospinal fluid due to dural tear after strenuous activity.