Orgasm is almost universally considered to be one of the most euphoric feelings the human body is capable of. That can make it all the more unnerving when such a special and important part of your life seems to also be a source of pain or discomfort, such as when you get an orgasm migraine.
However, it’s important not to scare yourself and assume an orgasm migraine is being caused by something serious, especially without ruling out likelier and more mundane possibilities.
Just as orgasm and sexual stimulation occur when many bodily processes work in concert together, so too are there multiple possible factors at play when a migraine is experienced during or after an orgasm.
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Headaches can be brought on by a number of causes, such as dehydration or stressful life events. Cardiovascular functioning also plays a major role in both sexual activity and headaches. In fact, all three of these factors are integral to orgasmic functioning, while a dysfunction with any one of them can lead to the onset of headaches.
Headaches experienced during sex are commonly felt on both sides and at the back of the head. They can be categorized into two:
Pre-orgasmically, felt as a dull ache during mounting sexual excitement
Orgasmically, felt as a sudden, even explosive headache during or just before orgasm, then followed by throbbing sensations
Orgasms involve extremely high levels of brain activity. Those with predispositions or sensitivities to headaches, even if they are not felt at any other time, could be experiencing the exacerbation of headache symptoms that normally remain under the threshold of awareness during the regular, non-orgasmic experience.
Ruling out contributing factors is helpful in discovering what is and isn’t contributing to an orgasm headache.
What’s common to all is that the orgasm is accompanied by rhythmic, involuntary neuromuscular contractions in the pelvic floor, followed by a period of decreased neuromuscular activity. Depending on the individual, though, the strength and breadth of those contractions can vary widely, and involuntary orgasmic contractions can occur just about anywhere in the body.
For headaches involving a high amount of neck tension, that tension can easily be increased during a particularly strenuous build-up to orgasm.
This tension and pain may not be felt until after sexual activity because sexual activity brings about heightened dopamine and opiates, which dull pain. As sexual activity escalates, the likelihood of noticing low-level tension in the body goes down, as you would be more focused on the sexual act itself.
The very pleasure being pursued can itself mask the musculoskeletal discomfort that otherwise would signal a need to exert less, not more.
A simple way to test if this is contributing to orgasm migraine is to be gentler with your body during sexual activity, especially with your upper spine. Straining the neck and face unnecessarily is one of the main causes of migraines in general, and many people are in the habit of achieving orgasms with heavy amounts of exertion.
Physiologically, it’s not necessary to exert large amounts of strain to stimulate the neural pathways to orgasm. In fact, the orgasm itself is more of an extreme release of tension, and sexologists as far back as the 1940s had clinical success¹ discharging neuromuscular tensions through freer, less strained expression of orgasmic pleasure.
Furthermore, pre-orgasmic headaches have been proposed to arise from excessive contraction of neck and jaw muscles during sexual activity. Thus, they may be avoided by conscious relaxation of these muscles during intercourse.
It may go against sexual habits, but if you can achieve an orgasm in a more relaxed way or with less physical strain on your head, neck, and shoulders, you can find out if your orgasm migraines are being caused at least in part through neuro-musculoskeletal strain—they almost always are (or at the very least, accompanied by it).
If reducing strain is effective in reducing the occurrence or severity of orgasm migraines, it’s worth investigating how your head and neck area became so vulnerable. The so-called “text neck syndrome”² is causing unprecedented levels of upper spine and neck pain.
Excessive time at a computer also adds to upper spine strain, which could easily result in headaches just when orgasmic pleasure gives way to the musculoskeletal dysfunction lying underneath the surface.
Sexual excitement is much like cardio in that it tests the elastic health of your blood vessels. This goes all the more for penile and vaginal tissues that fill up with blood for extended periods of time.
If you suspect cardiovascular issues are contributing to or causing headaches both during and after orgasm, then it stands to reason that you would also experience at least some headaches during high-cardio activities in general.
Thus, presumably, physical exertion associated with sexual activity can be one factor precipitating exertional headache in those who are predisposed.
Of course, excitement levels shift dramatically during sexual escalation, and there’s far more to an orgasm than a continual boost in your heart rate. Most sexual activity is characterized by a broad range of effort where more intense exertion is interspersed with deep diaphragmatic breathing.
For these and other reasons, orgasm seems to have as much to do with relaxation as it does with excitement.
Furthermore, especially in males (for whom ejaculation almost always accompanies orgasm), the peak of the orgasm is a function of the parasympathetic nervous system, while the erection of genital tissue is sympathetic in nature.
All the same, the quality of your cardio functioning is a major factor in the ability to happily reach orgasm and then subside into the post-orgasmic feeling of release without causing undue strain on your blood vessels. Reducing strain during sexual activity not only alleviates tension on the delicate muscles of your neck and skull (as described in the previous section) but also helps your cardiovascular system more smoothly adapt to the highly variable demands being placed on it.
Proper hydration is an easy and important first step to ensuring that your body is ready when cardiovascular demand increases. Because the body increases its production of hormones and fluids when it is aroused, the need for water increases even as one is less likely to break their trance-like focus on the sensation of pleasure.
Don’t hesitate to pause and reach for a glass of water during sexual escapades, especially those with extended duration.
Diet also plays a role, and even the most recent food choices can alter your body’s ability to handle shifting cardiovascular demands.
For example, during times of high-intensity exercise, blood flow to the GI tract is reduced by up to 80%, and it might be better to time eating away from sexual activity. Better yet, consider a meal after the activity, not before.
The availability of cardiac reserve is crucial because sexual activity puts increased demand on your blood vessels’ ability to expand and contract to accommodate rapidly shifting patterns of blood flow. Headaches can be typically thought to be caused or worsened due to particular constriction patterns and blood flow within the brain.
In considering sexual activity as akin to exercise—in particular, aerobic—it is no wonder that those who maintain fitness usually report greater enjoyment of sex.
For example, it became widespread knowledge that the Olympic Committee in recent years took to giving out condoms to the athletes because they knew from experience that extremely vital people in heightened physical condition are bound to have healthier sex drives.
Without trying to ruin “the mood,” it stands to reason that making the same considerations before sex as you would make before an aerobic workout will help.
In addition to eating only lightly in the time before sex, a mild “warm-up” period will help the body adjust to more intense cardiovascular demands. This can be achieved by elevating the heart rate through some other activity before engaging in sexual activity. It can also be done by simply devoting more time to a slower, more gradual buildup of excitement in the bedroom (e.g., by increasing foreplay).
Not letting the need to rush to fit sex into a busy schedule will help. This may require setting stronger boundaries against life stressors that seem averse to your need to be free of obligations from time to time.
The link³ between cardiovascular health and migraines is well-established. It may help to take a simpler approach to orgasm-related migraines by framing the issue as a singular calling to improve cardiovascular health for the purpose of not just pleasure but for overall health and longevity as well.
Note that the correlation between migraines and general cardiovascular health issues was higher in those suffering from migraines with aura (see the study in the previous link).
Some researchers hypothesize that migraines (and cardiovascular issues) increase with elevated homocysteine levels⁴ in the blood, which vitamins B6, B12 (especially the methyl form), and folic acid can help reduce.
Vitamin B2 (Riboflavin) may support the contribution of mitochondrial dysfunction in the development of migraine. It has been shown to benefit patients suffering from migraine in several studies.
There has also been interest in coenzyme Q10 as a possible treatment for migraines, as mitochondrial dysfunction may play a role in migraine pathogenesis. Several studies have shown a benefit in this context, but larger studies are needed.
Somewhat counterintuitively, emotional health may play as much or more of a role in chronic pain of all sorts. Though once dismissed, clinical evidence is accumulating that shows the statistical efficacy of mind-body treatment programs for chronic pain.
Indeed, placebo effects are very real, with one study showing that a placebo was 50%⁵ as effective at reducing migraine pain as the actual drug.
In his book, The Function of the Orgasm,⁶ pioneer sex researcher and psychiatrist Wilhelm Reich compared different types of headaches. He found they each had consistent patterns of emotional trauma and sexual dysfunction underlying them. As a patient’s underlying emotional pain and frustration were finally addressed, their neuromuscular tensions became much easier to treat.
Today, somatic (mind-body) therapies are gaining traction to the same ends, treating the emotional and physical complications surrounding both migraines and sexual issues.
Randomized clinical trials⁷ show evidence suggesting treatments such as massage therapy, physiotherapy, relaxation techniques, and spinal adjustments might meet or exceed the efficacy of at least two common prescription migraine drugs.
At the same time, there are extreme cases⁸ (though rare) where orgasm migraines are found to be caused by serious issues such as aneurysms. This makes it all the more important to rule out lesser potential causes because there are many factors that both contribute to migraines and are necessary for a healthy and pain-free sex life.
Experiencing an orgasm migraine can be unfortunate, given the activity involved. Even though its causes are hard to isolate, there are numerous treatments and lifestyle changes that will likely lead to not just fewer migraines but greater self-awareness as well.
It can be all too easy to fixate on a physical symptom as though it is isolated from other aspects of your health and well-being. However, as interdisciplinary studies and collaborations in the health sciences fields increase, so too does the body of knowledge necessary to answer some of the most pressing questions of sexual health.
Thus, when you experience an orgasm migraine, consult your doctor to rule out likelier possibilities that you can easily do something about.
Altered placebo and drug labeling changes the outcome of episodic migraine attacks | Science Translational Medicine
The function of the orgasm | Wilhelm Reich Museum