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When sex and headache are considered together in the same context, the result typically is something along the lines of “Not tonight honey . . . I have a headache.” But sex and headache (particularly migraine headache, most relevant to this Toolbox) are linked in a variety of ways.

First, while the experience of acute migraine headache with associated nausea, vomiting, and hypersensitivity to a variety of environmental stimuli obviously may preclude the desire for sex or ability to achieve orgasm, research has indicated that women may find sex – particularly sex resulting in orgasm – to be effective in terminating that attack or, at least, reducing symptom intensity. Giving lie to the “not tonight honey . . .” cliché is other research which found that women who suffer from migraine tend to score relatively high on surveys assessing “sex drive.”

Second, it is important to know that many of the medications commonly used in migraine management may reduce sex drive or impair sexual performance, and a few even may adversely influence fertility. For example, although there is not much evidence to suggest that the selective serotonin re-uptake inhibitors (SSRIs) such as fluoxetine (eg, Prozac; Lilly) and paroxetine (eg, Paxil; GlaxoSmithKline) are effective when used for migraine prevention, migraine is co-morbid with both depression and anxiety (ie, the conditions occur together in the same individual more often than would be expected by chance alone). The SSRIs thus are prescribed frequently for migraine patients, and in both males and females all the SSRIs may reduce sex drive and inhibit or prohibit orgasm; less often they may produce erectile dysfunction. Verapamil, a calcium channel blocker, is frequently prescribed for migraine prevention, and while this drug does not affect libido or sexual performance, it may decrease sperm motility and thus promote infertility. Beta-blockers and cyclic antidepressants, 2 classes of drugs also commonly prescribed for migraine prevention, may cause erectile dysfunction in men.

Although individuals afflicted with migraine rarely report orgasm as a trigger for migraine attacks, there is a primary headache disorder distinct from migraine termed “orgasmic headache” (or “benign sexual headache/explosive type”). This disorder is characterized by sudden, severe headache developing at peak sexual excitement and persisting for a variable length of time (minutes to hours). While many patients with this disorder also will report a history of typical migraine, the association is far from invariable. Although this headache disorder may occur in both genders, it is more common in males. It may occur at any time during the years of sexual activity, and its course is erratic; one may suffer this “explosive” orgasmic headache frequently and consistently for a period of time and then experience spontaneous and permanent remission of the headaches. Because orgasmic headache also may occur as a consequence of potentially serious medical conditions (eg, brain aneurysm), the diagnosis of the benign sexual headache requires confirmation by a healthcare provider skilled in headache diagnosis.

These are only several among the many issues which link headache and sex. If you are a headache patient and are concerned that your headaches – or their treatment – are exerting an adverse influence on your sex life or fertility, this is an issue well worth addressing with your healthcare provider.