Everything You Wanted to Know About Sex and Migraine (But Were Afraid to Ask!)

*This blog is intended for people aged 16 years and older*

Medically reviewed by: Dr. Megan Donnelly

The old joke about avoiding sexual activity—”not tonight, honey, I have a headache”—contributes to the stigma that affects people living with migraine and other headache disorders. The truth about sex and migraine? It’s complicated. Sex can provide headache relief for some, but not for others. We will cover information on all aspects of sex and migraine including headaches during sex, sexual dysfunction from migraine medications, as well as tips for improving sexual activity while living with migraine.

First, let’s look at an interesting 2013 study from the University of Munster in Germany. The experts distributed a survey to one thousand patients diagnosed with either migraine or cluster headache. 

Here are some of the conclusions the surveys yielded:

• Around 60% of people with migraine reported an improvement of their headaches with sexual activity¹ 
• Of the people with migraine who found improvement in their headaches with sexual activity, over one-third of the males and almost 14% of the females used sexual activity as a regular therapeutic tool.¹  
• About 43% of people with migraine found that their headache changed shortly after orgasm or maximal excitement, almost 18% reported the change with the time of orgasm, 20% found the change at the beginning of sexual activity while another 20% had the change within 30 minutes of orgasm or maximal excitement. This change did not depend on type of sexual activity, partner, time of the migraine attack or position during sex.¹

How Does Sexual Activity Impact Migraine?

• Interestingly, orgasm and pain affect some of the same areas of the brain, including the cortex, hypothalamus and more.² 
• Orgasms stimulate the production of endorphins, marvelous neurochemicals released from the brain that act like opioids, providing rapid pain relief that is even stronger than morphine! To put it in a simple equation: sexual orgasm=endorphin production=pain relief or analgesia.
• During a migraine attack, people may have lower levels of certain neurotransmitters like dopamine and serotonin. Both of these neurotransmitters are released during sexual activity. 
• Sex may also be beneficial for migraine because it distracts a person from the pain.

So that’s the good news regarding sex and migraine. 

Unfortunately, about one-third of people with migraine who answered the survey found their headaches worsened with sexual activity.¹

Whether you have migraine or not, some people experience a rare headache disorder called Sex Headache.³

The formal name of this condition is Headache Associated with Sexual activity.³ It can happen with any sexual arousal including masturbation and is sometimes referred to as an orgasm headache for this reason. In two-thirds of people who experience sex headache the pain occurs on both sides of the head rather than one side of the head.³ In 80% of people, the pain is either widespread or located on the back of the head (occipital region).³ It usually lacks migraine features and is described as very intense pressure, the feeling as if one’s head might explode.³ 

According to a paper published in 2010, Sex Headache occurs four times more often in men, and they are usually in their 40s when it first happens.⁴ People with a history of migraine, exertional headaches, or cough headaches may be more likely to get orgasm headaches.⁴ It may start as a dull headache that builds with excitement. Or it can be suddenly intense, usually around the time of climax/orgasm. This is the more concerning form of orgasm headache.⁴

While usually harmless, it can be a sign of something more ominous, such as a problem with the blood vessels in the brain. For people who experience sex headache that starts intensely and suddenly, they should seek emergency medical care, especially if it’s their first time ever experiencing it, and/or if it is the worst headache of their life. It can be a sign of aneurysm (out-pouching of an artery), dissection (tear), or spasm of an artery (a condition called Reversible Cerebral Vasoconstriction Syndrome or RCVS for short). 

If the vessels are reassuringly normal on imaging, then orgasm headache is deemed “benign” or non-harmful. Luckily, there are some good treatment options for it, such as pre-treating 30 minutes before sex with non-steroidal anti-inflammatory drugs. The other good news is that orgasm headache is usually limited: Half of patients with sex headache will have it for about 6 months after which it resolves and never returns. Some people only have one attack in their life.

Of note, physical activity, especially intense workouts, as well as coughing or Valsalva (bearing down), can also cause intense headaches that are very similar to orgasm headaches. So why do orgasm, exertion, and even coughing sometimes cause intense headaches? 

The current thought is that all three types of headache syndromes are related. 

Scientists are not entirely sure, but it is thought to be related to blood vessel changes, even when the ominous conditions have been ruled out. It is known that blood pressure quickly elevates around the time of orgasm, with intense exercise, and with coughing, and then blood vessels dilate. This could be what causes the pain. Why does this happen?

There are a couple of theories: 

• One thought is that valsalva (bearing down) causes vessel changes and rise in blood pressure.⁵ It appears that people who have any of the 3 headache syndromes (orgasm, exertion, cough) may have impaired auto-regulation of their blood flow due to their blood vessels dilating too much. 
• Another theory is that when someone climaxes or is exercising vigorously, there is a surge of their sympathetic autonomic nervous system which causes a release of adrenaline (also known as epinephrine). This gets your heart rate pounding, similar to  a “fight or flight” response. It really should be called the “fight, flight, fright, or F*** response” (The 4 Fs of stress). This in turn may cause the inappropriate vessel dilation.

Migraine Medications and Sexual Dysfunction

Some treatments used for migraine prevention can affect sexual function, meaning a person may have delayed, infrequent or absent orgasms or erectile dysfunction. Certain antidepressants, anti-seizure medications and blood pressure medications can cause sexual dysfunction. If this occurs, talk to your healthcare provider about lowering the dose, changing the timing or switching medications to possibly reduce side effects.

What Are Ways To Improve Sexual Activity While Living With Migraine?

• Talk to your health care provider! There are a variety of new acute and preventive treatments available for people with migraine that may be able to help decrease the severity and/or frequency of migraine attacks. A healthcare provider can also discuss tips and ways to improve your sex life. Oftentimes, patients can feel embarrassed to bring up these issues with their provider, but it is their job to help, and your provider has “heard it all” before.
• Communicate openly and honestly with your partner. Your partner needs to know how you are feeling and if you need support. Communication can even help foster intimacy.
• Choose a time of day to engage in sexual activity when you have less pain.⁶ Some people have more pain in the morning while others have more pain at night. Do what works best for you.
• If you are willing to experiment to see if sexual activity makes your migraine attack better or worse, try gentle exploration of foreplay or sex, perhaps on a day with a less severe attack.
• The Mayo Clinic recommends that, if needed, it can help some people to take a more passive role in intercourse if that helps to prevent their headaches, though this doesn’t help for everyone.⁷
• According to Dr. Hutcherson in an interview with Practical Pain Management, “For patients whose pain is exacerbated by specific positions and postures, choose positions that put less pressure on the area that causes pain and use pillows to support that area.”⁶ 
• Don’t be afraid to ask your healthcare provider for a referral to a sexual therapist or a psychologist trained in sexual therapy.⁶

Sex can be a fun way to relieve migraine symptoms, but if it’s not for you there are now lots of options for treating and preventing your migraine attacks.

Resources

1. Dateability – Dating app designed for the disabled and chronically ill communities
2. How to Talk to a New Dating Partner About Your Chronic Illness and Disabilities, According to Health Psychologists
3. Disability Visibility book

References

1. https://pubmed.ncbi.nlm.nih.gov/23430983/
2. https://www.sciencealert.com/here-s-what-happens-to-your-brain-when-you-orgasm
3. https://ichd-3.org/other-primary-headache-disorders/4-3-primary-headache-associated-with-sexual-activity/#:~:text=Description%3A,absence%20of%20any%20intracranial%20disorder
4. https://doi.org/10.1007/s10194-010-0261-9
5. https://n.neurology.org/content/88/16_Supplement/P2.158
6. https://www.practicalpainmanagement.com/treatments/psychological/improving-sex-lives-patients-chronic-pain
7. https://www.mayoclinic.org/diseases-conditions/sex-headaches/symptoms-causes/syc-20377477

Authors

Dr. Megan Donnelly is a graduate of Lake Erie College of Osteopathic Medicine. She completed her internship, neurological residency, and headache fellowship at the Cleveland Clinic. She also received specialized training in Women’s/Obstetric Neurology from University of Pittsburgh Medical Center. She is board certified in both Neurology and Headache Medicine. She is Lead Neurologist at Novant Health, in Charlotte NC. She is also Adjunct Professor Medicine at UNC School of Medicine and Assistant Professor of Medicine at Campbell University School of Osteopathic Medicine.

Lisa had migraine attacks for most of her adult life before being diagnosed with migraine disease. A communications strategist, writer, and former radio announcer, she lives in the Boston area, where she advocates for her fellow migraine patients every chance she gets.

Leigh Serth graduated from the University of Rhode Island with a B.S. in Human Development, Counseling and Family Studies. After graduating she spent time as a nanny, a personal secretary and a bookkeeping assistant, all while honing her skills in various types of computer work, video and audio editing, copyediting, and writing. Leigh puts those and many other skills to work as Director of Operations for the Association of Migraine Disorders where she manages the day-to-day operations of this small but dynamic organization. Leigh has been with AMD since its inception in 2012 and has played an integral role in the organization’s growth and development over the years, most notably working on the successful provider education course A Migraine Toolbox. She also serves as Treasurer on the organization’s executive board.