Headache 2011 American Headache SocietyPublished by John Wiley & Sons, Inc. doi: 10.1111/j.1526-4610.2011.01928.x
HEADACHE Toolbox
together in the same context, the result typically
expected by chance alone). The SSRIs thus are
is something along the lines of “Not tonight
prescribed frequently for migraine patients, and
honey . . . I have a headache.” But sex and
in both males and females all the SSRIs may
headache (particularly migraine headache, most
reduce sex drive and inhibit or prohibit orgasm;
relevant to this Toolbox) are linked in a variety of
less often they may produce erectile dysfunction.
Verapamil, a calcium channel blocker, isfrequently prescribed for migraine prevention,
First, while the experience of acute migraine
and while this drug does not affect libido or
headache with associated nausea, vomiting, and
sexual performance, it may decrease sperm
hypersensitivity to a variety of environmental
motility and thus promote infertility. Beta-blockers
stimuli obviously may preclude the desire for sex
or ability to achieve orgasm, research has
drugs also commonly prescribed for migraine
indicated that women may find sex – particularly
prevention, may cause erectile dysfunction
sex resulting in orgasm – to be effective in
terminating that attack or, at least, reducingsymptom intensity. Giving lie to the “not tonight
Although individuals afflicted with migraine
honey . . .” cliché is other research which found
rarely report orgasm as a trigger for migraine
that women who suffer from migraine tend to
attacks, there is a primary headache disorder
score relatively high on surveys assessing “sex
distinct from migraine termed “orgasmic head-
ache” (or “benign sexual headache/explosivetype”). This disorder is characterized by
Second, it is important to know that many of
sudden, severe headache developing at peak
the medications commonly used in migraine
sexual excitement and persisting for a variable
management may reduce sex drive or impair
length of time (minutes to hours). While many
patients with this disorder also will report a
adversely influence fertility. For example, although
history of typical migraine, the association is far
there is not much evidence to suggest that the
from invariable. Although this headache disorder
selective serotonin re-uptake inhibitors (SSRIs)
may occur in both genders, it is more common
such as fluoxetine (eg, Prozac; Lilly) and
in males. It may occur at any time during the
paroxetine (eg, Paxil; GlaxoSmithKline) are
years of sexual activity, and its course is erratic;
effective when used for migraine prevention,
one may suffer this “explosive” orgasmic head-
migraine is co-morbid with both depression and
ache frequently and consistently for a period of
anxiety (ie, the conditions occur together in the
permanent remission of the headaches.
headache patient and are concerned that your
Because orgasmic headache also may occur as
headaches – or their treatment – are exerting an
a consequence of potentially serious medical
adverse influence on your sex life or fertility, this
conditions (eg, brain aneurysm), the diagnosis
is an issue well worth addressing with your
of the benign sexual headache requires confir-
mation by a healthcare provider skilled in head-
issues which link headache and sex. If you are a
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