Sex and headaches have a complicated relationship. While engaging in sexual activity may be the last thing on the mind of someone suffering a migraine, research has shown sex may relieve migraines for some people.

However, it can also make things worse.

The link between migraines and sex

A migraine is more than just a bad headache. In addition to throbbing pain typically experienced on one side of the head, migraineurs often report symptoms such as nausea, chills, and sensitivity to light and sound. Approximately 14% of the global population report experiencing at least one migraine per year.

Stovner LJ, Hagen K, Linde M, et al. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain. 2022;23(34).

“Although 60% of migraine patients surveyed reported an improvement in their headaches with sexual activity, one-third of those with migraines found their headaches worsened with sex,” Dr. Donnelly says. 

While researchers aren’t sure why some migraineurs find pain relief during sex, Dr. Donnelly says it may be due to the production of endorphins that occurs during an orgasm. Another theory is sex may distract migraineurs from their pain.

A viable prescription?

While there’s still ongoing research on whether sex can make or break a migraine, chronic headaches can affect sexual intimacy. 

A 2019 study found sexual dysfunction is common in female migraineurs, with acute headaches resulting in loss of sexual desire.

Pradeep R, Sundarmurthy H, Karan V, et al. Prevalence and predictors of female sexual dysfunction in migraine. Ann Indian Acad Neurol. 2019;22(3):291–294.

In addition, the longer the duration of migraines, and the more frequent they were, the lower the sexual functioning among the migraineurs.

“Treating migraines may positively impact sexual dysfunction, but individual responses can vary,” Dr. Donnelly says. “Addressing sexual dysfunction with patients requires open communication. Physicians can broach the topic respectfully by integrating questions about sexual function into routine health assessments, normalizing the discussion and creating a comfortable environment for patients to share concerns.”

Recent research on the sexual well-being needs of patients with chronic conditions, such as migraines, confirms this. A review by researchers in Austria found that patients want their doctors to initiate discussions about sexual concerns, and treat these issues trustfully and respectfully. Most of the patients wanted to see the issue of sexuality included in routine care.

Aydın M, Bitkin A, İrkılata L, et al. The effect of migraine and tension-type headaches on female sexual functions: a prospective, cross-sectional, controlled study. Turk J Urol. 2018;44(5):418–422.

Dr. Donnelly says doctors might also consider incorporating the potential pain-relieving effects of sex into the overall treatment approach for migraines.

This may involve discussing with patients the role of regular, consensual sexual activity as a complementary aspect of managing migraine symptoms.

“However, individual responses vary, so treatment decisions should still be personalized based on each patient's medical history, preferences, and overall health,” Dr. Donnelly says.

She adds that doctors can talk to their migraine patients about several steps that can potentially improve sexual activity, including the following.

• Communication: Openly discuss migraine patterns, triggers, and concerns with their partner to create understanding and support.

• Timing: Choose times for sexual activity that align with periods of lower migraine risk, considering factors like stress levels and medication effectiveness.

• Pain management: Employ migraine-specific medications as prescribed by their HCP to better manage pain and reduce the likelihood of migraines during sexual activity.

• Relaxation techniques: Incorporate relaxation techniques, such as deep breathing or mindfulness, to help manage stress and potentially decrease migraine frequency.

• Healthy lifestyle: Maintain a healthy lifestyle with regular exercise, balanced nutrition, and adequate sleep, as these factors can positively impact both migraines and overall well-being.

When sex is the culprit

“Coital cephalalgia, or sex headache, is believed to stem from heightened intracranial pressure during sexual activity, though the exact pathophysiology remains elusive,” she explains. “A comprehensive workup for patients presenting with this condition should encompass a detailed medical history, thorough neurological examination, and appropriate imaging studies to exclude underlying etiologies.”

In terms of treatment, Dr. Donnelly says a multidisciplinary approach is often necessary. 

“Pain relievers may offer symptomatic relief, while prophylactic medications could be considered for recurrent cases. Indomethacin is typically the treatment of choice,” she says. “This is given approximately 30 minutes prior to intercourse as prophylaxis for sex headache. Identifying and addressing potential triggers is crucial.”

Most migraines are treatable

Migraine treatment has evolved over the years, with newer treatment options including triptans, such as sumatriptan, zolmitriptan, and rizatriptan, which are all selective serotonin agonists.

Nicolas S, Nicolas D. Triptans. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. March 7, 2023.

"Migraines are often treatable, and many patients find relief through various interventions," Dr. Donnelly says. “Family doctors can manage and treat migraines, and in many cases, they serve as the first point of contact. They may recommend lifestyle modifications, pain relievers, or preventive medications."

If the initial treatment regimen isn't effective, Dr. Donnelly says a referral to a neurologist may be considered. "There are various medications and treatment approaches available for migraines, including different classes of preventive medications, acute pain relievers, and lifestyle adjustments,” Dr. Donnelly says. “If one treatment isn't working or causes unwanted side effects, doctors can consider making adjustments and exploring alternative options tailored to the patient’s individual needs.”