Headache roams over the desert
Blowing like the wind
Flashing like lightning
It is loosed above and below.
Flashing like a heavenly star
It comes like the dew
It stands hostile against the wayfarer
Scorching him like the day.

It has struck him
And like one with heart disease, he staggers
Like one without reason he is broken
Like one thrown in the fire
He is shrivelled

Headache is like the dread windstorm
No one knows its course
No one knows its full time or its bond.

Anyone who has migraine or has listened to others describe their migraine will recognize at once that these words serve as a poetic exposition of the migraine experience. What is especially intriguing about the poem is its ancient lineage; it is the work of a now unknown author writing in the Fertile Crescent of Babylonia over 3000 years ago.

This raises a question: how has a disorder which has caused so much human suffering persisted at such high prevalence for so very long? If migraine is indeed genetic in origin, why did the inexorable force of natural selection not prune migraine from the shrub of human evolutionary development many centuries ago? Put another way, what possible advantage could migraine confer that would enable the disorder to escape the merciless scythe of evolution? Some reasonable but ultimately difficult to prove hypotheses have been offered. Here we now offer a new one.

Migraine and Sexuality

For whatever conflation of reasons, misogynistic or otherwise, there persists in America a prevailing cultural trope that females are prone to using headache as an excuse to avoid engaging in sexual intercourse. Given that migraineurs are disproportionally female and that as many as 28 million American females have active migraine, it should not be surprising that this cliché has been extended to imply that it is females with migraine who most commonly employ the “headache excuse” and, yet a step further, that female migraineurs are inherently deficient in libido.

Using the Female Sexual Function Index (FSFI), a validated survey commonly used in clinical care and research involving females with sexual dysfunction, this magazine’s editor and his colleagues sought to compare the level of sexuality and various aspects of sexual function in a sexually active and heterosexually self-identifying female migraine population relative to a matched female population without migraine or any other primary headache disorder. 

To summarize, our research subjects with migraine reported a higher level of self-perceived sexuality, more positive sexual function and a greater frequency of penetrative sexual intercourse than matched controls free of migraine. 

Aside from exploding the myth that female migraineurs are hyposexual, these results suggest an intriguing alternative answer to the question of why migraine has persisted in human society. The primary purpose of natural selection is propagation of the species. If migraine does convey an increase in female libido and, with this, increased heterosexual activity favoring an increase in progeny, then migraine may be advantageous to the species. If true, is it possible that over the centuries to come we will witness a progressive increase in the proportion of migraineurs within the general population? In other words, natural selection favoring migraine?

An intriguing hypothesis, perhaps, but one that likely will require a multigenerational prospective study to prove.