Sudden severe headache during sex

Dear Ask The Doctor: I recently discovered that I am having small seizures and have also suffered from migraines most of my life. I recently had disc fusion of my C5 C6 and after a long, hard recovery I am feeling pretty good. Unfortunately, I have experienced something very scary. I'm too embarrassed to tell my neurologist but after an orgasm over a month ago, I think I collapsed with the most excruciating pain in my head that caused my whole body to respond by tensing up, test confirm it wasn't a gran mal. I would have been okay with that if it hadn't happened again but as it began I stopped immediately and it wasn't as bad. It is accompanied by nausea, confusion, weakness and a persistent headache for a couple of weeks. The pain the second time was sharper, faster and I am concerned. I am 47, a domestic violence counselor and mother of 5 and while I have had some stuff happen in the last 10 years like gall bladder, knee and hernia surgery, I have a lot to look forward to. Any ideas?

Dear Maria: Sex headaches are headaches brought on by sexual activity, especially an orgasm. You may notice a dull ache in your head and neck that builds up as sexual excitement increases. 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. Since you do have a history of seizures and migraines, it is important in this case to rule out an intracranial bleed. I would recommend that you talk to your neurologist about your symptoms. Sometimes brain bleeds start with a tiny leak, which may temporarily seal itself off, after which the headache may temporarily resolve. This is called a "sentinel bleed." A sentinel bleed is an important warning sign of impending rupture. It's crucial to recognize and diagnose a sentinel bleed because it provides a window of opportunity to identify and repair an aneurysm before it completely ruptures.