It’s the most tired of all phrases used to turn down sex: “Not tonight, I have a headache.” So cringe, even if you really do have throbbing head pain. It’s tempting to invent some other excuse so you don’t have to endure your partner’s eye roll (followed by mutual guilt about potential hurt feelings). For people who are living with migraine, this isn’t some occasional or hypothetical relationship issue—the chronic neurological condition’s symptoms pose a very real impediment to intimacy. Not just the migraine symptoms that occur during an attack, like severe head pain, nausea, sensitivity to smells and bright lights and dizziness—all of which hardly put you in the mood. Even migraine’s milder prodrome and postdrome (pre- and post-headache) symptoms, like irritability, fatigue, and muscle stiffness, can easily and understandably tamp down your feistiness. It’s no surprise that in one study, a quarter of people with chronic migraine reported that the condition has changed the frequency and quality of their sex.
Since it’s estimated that 39 million Americans are living with migraine, according to the American Migraine Foundation, we’re talking about a big chunk of the population having their sex lives sabotaged at regular intervals. Yet despite the very obvious challenges, having migraine doesn’t need to mean having less sex, or wanting less sex. In fact, a study in the journal Headache found that people with migraine actually have higher levels of sexual desire than the rest of the population. Perhaps it’s nature’s way of telling us that pleasure can lead to relief; studies have also shown that sex can be more potent than drugs when it comes to easing headache pain. A few brain-chemistry factors at play: Orgasm floods the system with endorphins that act like natural painkillers, as well as the “happy hormone” serotonin. Meanwhile, physical contact also prompts release of the “love hormone” oxytocin, which is actually being studied as its own migraine treatment.
One study found that 60 percent of people who had sex while having migraine symptoms felt better afterward, with some experiencing complete relief. Of course, there’s the 40 percent who reported no benefit, and for a small percentage of people, sex can actually cause headaches. Plus, even if you’re told sex could ease your head pain, you might cringe at the idea of doing something so physical and sensory when all you really want to do is curl up in a dark room. Yet improving your sex life during those times when you’re feeling up for it definitely can have a positive ripple effect on your mental health, relationship, and overall well-being—and even help prevent future migraine attacks, alongside your other lifestyle and preventative measures. As with all things in your life with migraine, it’s all about figuring out what routines and rhythms work for you (and your partner). Here are a handful of good places to start.
Create space for rest—and sex.
Rest and downtime are so important when managing severe migraine, and if you’re rushing from one thing to the next at a frantic pace, you’re not only more likely to experience an attack, you’re less likely to find yourself in a moment where sex seems like an appealing idea. One idea is to try morning sex, if you haven’t lately—this kicks your day off with a boost of all those positive brain chemicals and avoids the sluggishness and fatigue that can too easily interfere with evening intimacy. That said, 4 to 9 a.m. is the time when migraines most commonly start. If mornings feel less than sexy for this reason, think about other times when you can create space for connection, maybe via sneaking in a mid-day “nap” with your partner who also works from home, or by crawling into bed an hour early to watch your shows together and seeing what happens from there.
Tune in to your hormones.
As you may have noticed, your menstrual cycle can strongly affect the rhythm of both your headache days and your sexual desire. And researchers believe that the connection between ever-shifting hormones and chronic migraine may explain why women disproportionately live with this condition. Identifying windows of time when you’re both in the mood for sex and unencumbered by symptoms can be a great way to work more intimacy into your routine. If you tend to get migraine symptoms right before or after your period, you could work backward from there to ID less-tricky time intervals and plan some couple time accordingly.
Consider medication side effects.
Some common preventative treatments for migraine, like antidepressants and beta-blockers, can have a negative effect on your sex drive. If you suspect your migraine medication is affecting your quality of life in other areas, speak with your healthcare provider, who may be able to suggest treatment options that are a better fit.
Skip the wine.
It can be tempting to live in the moment and have just one glass when you’re out at a romantic dinner, but it pays to keep in mind how this and other common migraine triggers (like that so-tempting charcuterie board, or an after-dinner cocktail lounge where the music is blaring) could sabotage your ability to connect physically later in the evening. Keep in mind how avoiding triggers doesn’t just help avoid migraine pain, it also keeps your sex life on track. Another example: If you know you’ll be going away for your anniversary, you could pay extra attention to avoiding migraine triggers in the days leading up to that, and put extra emphasis on self-care by hydrating and getting enough sleep, to help ensure that a headache won’t sabotage your fun.
Give if you can’t receive.
Some people with migraine find that, even if they’re fatigued post-migraine and not up for having sex or even being brought to orgasm, they have enough energy to give their partner pleasure. This can ease stress and tension and let you enjoy some of that beneficial oxytocin release associated with touch. Likewise, at times when a full-on sexual romp is way too much, mutual masturbation or even something as simple as holding hands or giving your partner a long hug can make you both feel more connected and content, and avert the buildup of resentment and tension.
Don’t be scared to go it alone.
Many of the brain-chemistry benefits of sex come from orgasm, so if you can’t bear the thought of anyone touching you amid migraine symptoms, you could still take matters into your own hands and enjoy similar pain-easing results. Some migraine patients find that even if they’re not feeling particularly aroused, an orgasm ultimately does help ease headache pain; it’s a pretty low-risk pain-management tactic to try, in any case.
Be open and honest.
Communication is key to ensuring that your partner doesn’t take your lack of interest personally or feel rejected when you inevitably say no to sex because you feel a migraine attack coming on, or are totally drained by one that just ended. Educating your partner about what migraine (as a neurological disease, not an excuse) really involves can also empower you to work together as a team on avoiding your triggers and adopting healthy lifestyle changes that could help you avert future migraine attacks—and eye rolls.
Find more on migraine management in our headache center: