Not Tonight Dear, I Have A Headache

Intercourse has been known both to ease migraine pain and to trigger a headache, but its effect depends on the person and the circumstances. We've all heard of (and maybe some of us have used) the old excuse Not tonight, honey, I have a headache. But the next time you feel a migraine coming on, sex might be the best remedy.

There are two schools of thought on this topic: One holds that sex, especially an orgasm, releases certain chemicals in the brain that work to alleviate a migraine; the other holds that sex can actually cause a headache by increasing blood pressure and causing a dilation of the cerebral blood vessels. You'll have to do your own experimenting to find out whether sex has any effect on your migraines.

Migraines are genetic, and people susceptible to them are also more likely than the average person to develop other types of headaches. Although most migraine symptoms are similar — sensitivity to light, sound, and certain smells; nausea; and a constant throbbing pain — what causes a migraine is different for each person. According to Dr. Mark W. Green, director of Headache Medicine at Columbia University College of Physicians and Surgeons, there are thousands of genes and chemical combinations that set up the predisposition for migraines.

While the idea that sex might cure a migraine sounds almost too good to be true, a recent study in the journal Headache reports that the neurotransmitter serotonin is released during sex, creating an all-over feel-good sensation. In addition, an orgasm releases endorphins, which work to relieve pain, says Dr. Alexander Mauskop of the New York Headache Center. Endorphins, which are opiate-like chemicals, are associated with a happy, positive feeling and keep pain messages from reaching the brain. Unlike pain medications, which can take up to 15 minutes to work their magic, these chemicals work instantly, shutting down a migraine before it has a chance to take hold.

Sex, like exercise, is a physical activity, however, which for some migraine sufferers can trigger an attack. The exertion puts pressure on both the back and the neck, which can provoke a migraine in people prone to headaches.

Columbia's Dr. Green adds, "Headaches during sex are most often seen in people with migraines because these people have a genetic predisposition to develop headaches already." According to Dr. Green, sex can cause three different types of headaches, which can all lead to migraines: an explosive headache, a tension headache, and a positional headache.

The most common type of headache triggered by sex is the explosive headache, which occurs at the point of orgasm; it can actually have similar symptoms to those of a brain hemorrhage. Dr. Green suggests that anyone who experiences this type of headache for the first time seek a medical professional immediately after the incident to rule out a hemorrhage, or other brain injury, as the cause of the headache.

A tension headache — usually caused by stress, including tension that is brought on by the act of sex — feels more constrictive and usually goes away within 20 minutes.

The rarer positional headache can be harder to diagnose. Usually these headaches are experienced by people who have just had spinal surgery or an epidural — either of these procedures could result in a tear in the membrane surrounding the brain and spinal cord, called the dura, causing it to leak fluid. If a person with a torn dura were to rise from a reclined position, the loss of fluid would cause his or her brain to sag, which would trigger a positional headache. If the person were to lie down again, then the spinal fluid would pool, cushioning the brain, and the headache would go away.

Doctors may treat these types of headaches with IV fluids — caffeine and antiemetics. But fortunately, most positional headaches are mild; they tend to last only 24 hours and usually do not require treatment. However, if you've recently had spinal surgery or an epidural and you experience this type of headache, you should consult with your physician.

Though you may not yet know which group you fall into — those for whom sex is a cure for migraine or those for whom it's a cause — you're now aware that sex is one more possibility worth considering when you're trying to figure out your migraine triggers and the most effective treatments for your symptoms.

Last updated: March 21, 2008
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