Years ago when I lived in Ocean Beach, an seaside appendage of San Diego that somehow has never quite made it out of the late 1960s, it was my Sunday ritual to have a brunch of huevos rancheros and margaritas on the patio of Rosa’s, a small Mexican restaurant not far from the pier.

I was sitting at Rosa’s with friends one Sunday in the late morning when a woman unknown to me arose from a nearby table and came over to stand beside me. 

“Hello, Dr. Rothrock,“ she said pleasantly. “I’m sorry to bother you, but I just wanted to tell you that I found something that cures my migraines.“ Apparently I had seen her as a patient in the past. 

She then bent over to whisper in my ear. “I have sex with my husband,“ she confided, “and when – you know -  my headache immediately goes away.“ She straightened back up, blushing a bit now and smiling uncertainly.

“Well,“ I told her. “That’s great . It sounds like you’ve found a very pleasant cure.“ 

I glanced over to the table where her husband was concentrating on a plate of eggs, his eyes fixed on his plate.

“I know!“ She exclaimed. “And thank you so much.“

To this day I remain unsure what it was she was thanking me for, but her revelation to me was only the first of many orgasm-related migraine stories I was to hear recounted over the years to come. 

Sex, orgasm and migraine have a funny relationship. As discussed in a previous issue, there exists compelling evidence that female migraineurs possess a higher libido than a matched sample of non-migraineurs and that female migraineurs have a more active and...”successful” sex life (link to:  ). While there is definitely some validity to the old “not tonight, dear… I have a migraine“ chestnut (who in her right mind would want to make love when distracted by pounding head pain and intractable nausea?), it’s also true that many female migraineurs like the woman at Rosa’s Mexican restaurant find that sex – and orgasm in particular – may be helpful in terminating an acute migraine episode. Interestingly, I have never heard the same correlation described by a male migraine patient.

Paradoxically, peak sexual excitement, and orgasm in particular, may precipitate an acute, severe and but typically short-lasting headache in both males and females. When this happens repeatedly and no underlying structural neurologic problem is present, this is termed “primary headache associated with sexual activity“. This headache disorder may occur somewhat more commonly in migraineurs, and it afflicts both males and females. This obviously can put a real damper on sex, and for whatever reason I recently have evaluated in clinic a series of female patients who tell me they make a conscious effort to avoid orgasm during intercourse so as to  spare themselves the headache. While I have not examined the issue in any scientific manner, it is interesting to me that my male patients with primary headache associated with sexual activity are more likely to simply avoid sex altogether than to engage in sexual activity that stops short of orgasm.

Getting back to my patient who divulged her secret cure at Rosa’s on that morning so many years ago, I think what her experience tells us is that there are many ways to “skin the migraine cat“. While we have some truly wonderful new (and older) medications and devices to treat migraine, many of which I have played some small role in helping to develop, I appreciate entirely the “secret cures“ that my patients have identified and take no offense that they prefer those therapies to ones I might otherwise prescribe.

In this I’m only being faithful to my own experience. I have migraine myself, and while living in San Diego and working with a small group of colleagues to develop what became injectable sumatriptan (Imitrex), the first “designer drug“ for migraine,  I chose to treat my own migraine episodes by grabbing my surfboard, paddling out and letting the first cold wave that broke against my head immediately eliminate my headache. If such pleasant and healthy activities as sex and surfing are adequate to treat your acute migraine headaches effectively, more power to you.

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