Orgasm, Migraines, and Headaches

by Teri Robert Patient Advocate

**Does the "Big O" affect Migraines and headaches?**

Does the "Big O" cause or stop headaches and Migraine?

We've all heard the old joke, "Not tonight, dear. I have a headache." Right? Surprisingly enough, for some people, there definitely is a correlation between sexual activity and headache or Migraine that can be good!

The Bad News First For some people, sexual activity can cause headaches and trigger Migraine attacks called coital cephalgia (headache), exertional headache, or exertionally-triggered Migraine. Such headaches may be benign exertional headaches that can also be brought on by other strenuous activities. They may also be directly linked to orgasm or sexual excitement.

Coital headaches may have a duration of up to 24 hours, and are more common among men than women at a ratio of 4:1. Although such episodes are usually benign, it is important that they be correctly diagnosed to rule out organic causes. Tests used to confirm the diagnosis include CT scan, MRI, and MRA.

Headaches or Migraine attacks induced by sexual activity may strike prior to, at the time of, or following orgasm.

Such attacks have also been documented after masturbation. There are three patterns of occurrence for coital headache:1

  • Sudden onset: This pattern applies in 70% of coital headaches, and begins just before, during, or immediately after orgasm. The headache is severe, usually throbbing, and may build over minutes or be explosive. Average duration is several hours.

  • Subacute, crescendo headache: This pattern applies in approximately 25% of cases. The onset is much earlier than orgasm, with intensity increasing until the time of orgasm. Frequently in the back of the head, the pain is dull and aching. Rarely, nausea and vomiting may occur.

  • Postdural headache: This is the least common of coital headaches. The pain occurs in the lower back of the head and is greatly increased then the patient stands. This form is more likely to be accompanied by nausea and vomiting.

A Brighter Side To the Bad News Once coital headaches are diagnosed benign, medications can be taken one to two hours before anticipated sexual activity to hopefully avoid coital headaches. Some medications that may be used are Indomethacin, DHE (Dihydroergotamine,) triptans --Imitrex, Zomig, Maxalt, Amerge, Relpax, Frova, and Axert --, Midrin, propranolol (Inderal), and common analgesics. If the problem persists, daily preventive medications may be in order. Care should be taken not to use the triptans, Indomethacin, DHE, or analgesics more than two or three days a week in order to avoid medication overuse headache, aka rebound.

The Good News In a journal article by Randolph W. Evans, M.D. and James R. Couch, M.D., Ph.D., the authors open by saying,

"Occasionally, orgasm can trigger a Migraine but, in others, can relieve a Migraine. Dr. Couch's data suggests that some women who decline, 'Not tonight, I have a headache,' may be avoiding an effective treatment."2

Study of Migraine relief with sexual intercourse in women was undertaken at the Headache Clinic at Southern Illinois University. For those who obtained relief through orgasm, the level of relief varied, but it is interesting to note that of those who obtained any relief, the largest subset is those who obtained complete relief. Of study participants:

  • 47.4% had complete relief

  • 48.5% had no relief, and

  • for 4.1%, orgasm made their Migraine worse.2

In comparing the efficacy of orgasm to that of Migraine abortive medications, orgasm is significantly less effective than triptans or DHE, but when it is effective, the onset of relief is faster than with medications.

Dr. Evans and Dr. Couch conclude their journal article with this statement,

"The issue of suppression of headache by orgasm does bring up the possibility of suppression of one multi-faceted, presumably neural origin syndrome (Migraine) by another neural event (perception of sexual orgasm). Perhaps there are other situations in which an indigenous neural process might be used to suppress Migraine. Certainly there are some interesting theoretical possibilities here."

Interesting possibilities, indeed! Although this study did not include men, Dr. Evans and Dr. Couch report there is anecdotal information suggesting that relief with sexual orgasm may occur in men, including men suffering cluster headaches.

As with so many issues with headaches and Migraine, we find that there wasn't a single answer to our initial question, "Does the "Big O" cause or cure headaches and Migraine?" In searching for answers to the question, both good news and bad news are found, but even for those for whom orgasm sometimes causes headaches or triggers Migraines, there are avenues of prevention to be explored. Don't give up or be embarrassed to approach your doctor with the problem. The answer might be simpler than you think.


1 Saper, Joel R., Silberstein, Stephen, Gordon, C. David, Hamel, Robert L., Swidan, Sahar. Headache Management: A Practical Guide to Diagnosis and Treatment of Head, Neck, and Facial Pain, Second Edition. Lippincott Williams & Wilkins, 1999, 241-242

2 Evans, Randolph W. & Couch, R. (2001). "Orgasm and Migraine." Headache: The Journal of Head and Face Pain 111 (6), 512-514.

Teri Robert
Meet Our Writer
Teri Robert

Teri Robert is a leading patient educator and advocate and the author of Living Well with Migraine Disease and Headaches. A co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association, she received the National Headache Foundation's Patient Partners Award and a Distinguished Service Award from the American Headache Society.