The Sexual Side of Migraine

Migraine and Sex?

Like oil and water, these two would seem a poor mix. Place them together, and immediately comes to mind the time-worn image of the disinterested female using “migraine” as a handy excuse to deflate the amorous male. That old cliché aside, it’s easy enough to accept that acute migraine invariably should serve as an anti-aphrodisiac, a brew of unpleasant symptoms destined to quench even the barest flicker of sexual desire.

Yes…and no. As with virtually every clinical aspect of the disorder, nothing is ever “always” with migraine. Migraine does not always worsen with use of an oral contraceptive. Or always improve with menopause. Or always activate following a glass of red wine. So it is with migraine’s relationship to libido generally and to sexual activity in particular.

Does Migraine Reduce Libido?

Specifically, does being migraine-prone reduce sexual desire and enjoyment? Not necessarily. In fact, there is evidence from clinical research trials that just the opposite may be true.  Published in Headache, the Journal of the American Headache Society, results from a relatively small study involving both males and females with either migraine or tension type headache indicated down that those individuals suffering from migraine reported a level of sexual desire 20% higher than those with tension type-headache.

The Female Sexual Function Index (FSFI) is a 19 item questionnaire that assesses female sexual function in 6 domains ranging from desire and arousal to satisfaction.  A recent study utilizing the FSI and published in Headache found that obesity-but not migraine-correlated with sexual dysfunction.  In the migraine patients surveyed, the frequency, severity and duration of headache attacks did not appear to influence sexual function.

Can Sex Serve as a “Treatment” for Acute Migraine?

In a study published in  Cephalalgia, the journal of the International Headache Society, investigators found that over half of those migraineurs who made love during a headache attack experienced more than a 50% reduction in their head pain. This “response rate” rivals that of many of the most widely used medications intended to treat acute migraine. About a third of those surveyed reported specifically using sex to treat acute migraine. 

Can Both be True? Does Migraine Correlate with a Higher Libido, and can Sex be Used as a Migraine Treatment?

Using a detailed written questionnaire and taking pains to guarantee patient anonymity, clinical investigators at one university-based headache clinic in Nevada assessed sexual behavior in a consecutive series of 200 female migraineurs and compared their responses to those from an identical number of migraine-free females matched for age, race/ethnicity, body mass index (BMI) and educational, socioeconomic and marital status. Compared to the migraine-free control subjects, patients with episodic migraine reported a higher mean libido, higher monthly frequency of intercourse and a higher likelihood of intercourse resulting in orgasm, and their mean score on the Female Sexual Function Index was significantly higher than that of controls. Similar to the results from the Cephalalgia study described above, about 25% of the migraine patients reported successfully using intercourse - and orgasm specifically - as a means to terminate a migraine attack.

At the biologic level, why should migraineurs have a higher libido than non-migraineurs? And why should intercourse be effective in treating acute migraine headache? Although a proven explanation remains elusive, the answers to these questions may reside at the molecular level. High levels of serotonin are associated with low sexual desire, and serotonin, a protein neurotransmitter important in cell-to-cell communication within the central nervous system, may be deficient in migraine.  Noting this relationship, scientists hypothesized precisely what the data from clinical trials have suggested: migraineurs may experience higher levels of sexual desire than others.  As for the therapeutic effect sexual activity appears to exert upon acute migraine, researchers have proposed that the release of pain-killing endorphins may play a key role.

Can Sex Trigger a Migraine Attack? 

Thankfully, that particular stimulus>response relationship is uncommon.  While as many as a third of migraineurs may report worsening of their acute migraine as a consequence of sex, rarely does engaging in sexual activity precipitate de novo an acute migraine attack.  What can occur in both migraineurs and individuals with no history of migraine is "primary headache associated with sexual activity", a true buzz-kill of head pain that tends to erupt suddenly during the time of peak sexual excitement (hence its informal name: "orgasmic headache").  This rather mysterious, alarming but ultimately benign headache disorder is experienced by about 1% of the general population, afflicts males more frequently than females and often ceases spontaneously after a period of a few weeks to months.

Is Sex Always "Good" for Migraine?

Unfortunately, no.  While sexual activity may be therapeutically helpful for some migraineurs some of the time, it should be noted that only a minority of the patients evaluated in the Cephalalgia study referred to above chose to engage in sex during a migraine attack. The combination of severe migrainous headache, nausea and an unpleasant sensitivity to being touched (so-called cutaneous allodynia) obviously can serve to quench one’s sexual desire.  While at times sex may be worth trying as an acute migraine treatment, there are also those times when quiet solitude and appropriate medication will be the more attractive, reasonable and effective option.

To privately assess your own level of sexual function, go to www.mdapp.co and use the Female Sexual Function Index calculator.