Sex and migraine headaches is such a taboo topic. It's just one of those things that is really hard to talk about. If sex triggers an attack for you, read on to learn what you can do right now. It is treatable.
When suffering from a migraine, sex is probably the last thing on your mind, so it’s easy to see why chronic migraines can reduce intimacy within a relationship. However, the link between sex and migraine headaches goes beyond its ability to stop your sex life in its tracks. Some believe that sex may trigger migraines in some individuals, while new studies are showing that sex may actually help relieve migraines.
Here’s a closer look at the link between migraines and sex.
It sure can, but it is rare. According to Migraine.com, about 1 out of 100 migraine sufferers will sometimes have painful headaches when sexually aroused. But I'm guessing those numbers are grossly understated.
A sex headache with severe pain can last anywhere from one minute to one day. And / or you might experience a more mild headache that could last up to three days. Dr. Andrew Charles, director of the Goldberg Migraine Program at UCLA, says that a "sex headache can be a short-duration attack or it can last up to 24 hours. If the sex headache lasts up to 72 hours, the headache has to be only mild in intensity to qualify for the diagnosis [of primary sex headache.]" 
The International Classification of Headache Disorders (ICHD-3) classifies a primary sex headache as “primary headache associated with sexual activity,” which is a headache that is brought on by and occurs only during sexual activity.
The formal definition is that a sex headache is either one or both of the following:
Migraine symptoms can arise during or after sexual activity. Some common migraine symptoms include neck pain, difficulty concentrating, fatigue, and food cravings. 
Since sex results in many chemical reactions in the body, not to mention the swirl of emotions, it is easy to see why some individuals may end up with a migraine after sex. The good news is that these migraines do not occur every time you have sex.
Surprisingly, men are more likely to experience migraines triggered by sexual activity, and it is hypothesized that changes in blood pressure, energy exertion or an increase of activity in the legs or buttocks may cause the migraine. Migraines triggered by sex may occur during intercourse or after orgasm, and the migraine may start gradually or may occur suddenly and explosively.
Although some individuals find that sex and migraine headaches go hand in hand, with sex triggering a migraine, new studies have actually shown that having sex may help to relieve migraines. German researchers recently did a study that found that 60% of migraine sufferers found sexual activity a successful treatment. Authors of this study noted that sexual activity may offer complete relief, or only partial relief, not only to migraine sufferers, but for some individuals that suffer from cluster headaches as well.
While 60% of the migraine sufferers studied said that they enjoyed some kind of pain relief after sex, many of those participants reported that sex completely alleviated their migraine symptoms. However, while most of the individuals found that sex relieved their migraines, about 1/3 of the migraine sufferers reported that the pain got worse after sex.
Researchers believe that it may be the endorphins released during sex may help to relieve the migraine, since they are the body’s natural painkillers. Although previous studies have shown that sex may provide migraine relief, this study was done on a much larger scale than previous studies, suggesting that for many individuals, sex may be a natural way to enjoy migraine relief.
There are not many well studied treatments specific to sexual induced migraine, but there are a variety of things that can be tried. It is treatable. So talk to your primary healthcare provider, or doctor about your suspected sex triggered migraine attack.
Generally speaking it should go away. If it doesn't this is another prompt to get you to go to your doctor and discuss if something else could be an underlying cause.
Another thing to consider is that some medications used to prevent migraines can cause problems in the sexual arena. Especially if you are taking something to help lift depression. If you suspect your abortive or preventive migraine medication is the culprit, ask your doctor if there's another option you can switch to.
Please be aware that medications used for sexual dissatisfaction (I prefer that new term to dysfunction) can trigger a migraine attack. More specifically brand names like: Viagra (sildenafil), or Cialis (tadalafil) can trigger a migraine attack. So that’s something to keep in mind if you are planning to use those kinds of products. 
Now, if your sex and migraine headaches are related to exertion, going slowly can be helpful. But it's less likely that this will help solve all your issues.
If you have a migraine abortive medication that usually works for you, like a triptan or an anti-inflammatory, you can try taking it prior to initiating sexual activity. If this is not effective or you value spontaneity, ask your doctor about "long acting" triptans, such as Frovatriptan or Naratriptan, which possibly could be effective if taken up to 12-24 hours in advance. 
If your body is healthy and well rested you will be able to tackle everything in life much easier. BUT this is easier said than done with migraines wiping you out. Exercise is proven to help with sex and migraine headaches. So try these exercises to help keep you fit and relaxed:
Try to be strong and fit so you're able in the bedroom! BUT also remember to rest so your body can recover. It's easy to forget this bit. Don't keep pushing, let your body recharge its batteries.
Talking about what's going on is essential when it comes to sex. And solving problems together will bring you both closer.
Schedule it in. Make a date in your diary for a romantic interlude or just sex. Our schedules get busy, I know this might sound mundane and like there's no room for spontaneity - but this will help you get into the habit of making time for each other. Things can grow and change from there.
Try this - schedule your sexy times in first for one week and then plan your week around that! Have fun with it.
Keep track of how well your medications are working and be sure to work with your doctor to test new options if you suspect any of this could be causing problems in your sex life.
A good migraine prevention routine needs to include regular: sleep times and waking up times, meal times, and exercising. Proper hydration and good nutrition all come in to play.
Making more healthy lifestyle choices can help reduce dependency on your migraine medications too which is a win win.
"Fill your fun bank." Sex and migraine headaches means you need to enjoy every single day that you are pain free. Celebrate your good days with sex. 
Or, take some time here for romance. You may not feel up for sex, but building a strong level of intimacy will all get paid forward when it comes time for sex. Again, I recommend committing this to a date in your diary. Pick your favorite things to do together or try something new. Here are some ideas: a moonlit stroll, picnic, massage, midnight swim, dinner out, a nice long walk through a new park.
Keep a handle on your hormones. Yes, that means you men too! As we age our hormones change, so "we lose testosterone, estrogen, and progesterone - three hormones that greatly affect your sexual health and desire. A hormone specialist can check your levels and prescribe hormones that will restore much of your sexual pleasure." 
You might find a few sessions with a qualified counselor or therapist can help you get to the bottom of some of this. "Even if your insurance doesn’t pay for either of these, it may be well worth the investment to put the sizzle back in your sex life." 
Of course, while sex may be shown to provide relief from a migraine attack, sometimes your sex life can suffer as a result of chronic migraine attacks. Many migraine sufferers do not want to be touched when dealing with an attack, which not only affects your sex life, but the intimacy within your relationship as well.
Not feeling up to enjoying activities with a spouse can be tough on a relationship, which means that couples must be patient with each other and the situation.
Communication, understanding and support are all essential for couples who are affected by chronic migraine.
The Migraine World Summit covers difficult topics like this every year - here's the link:
Sex and migraine headaches references:
1. Primary Headache Associated with Sexual Activity. International Classification of Headache Disorders. Available [online] at: https://ichd-3.org/other-primary-headache-disorders/4-3-primary-headache-associated-with-sexual-activity/
2. Charles, A. MD (2020) What Should You Know About Sex Headache? Dr. Andrew Charles Answers the Most Common Questions. Available [online] at: https://www.migraineagain.com/sex-headache/
3. Health Central (2016) Migraine Triggered Intimacy. Available [online] at: http://www.healthcentral.com/migraine/c/9924/180789/migraine-triggered-intimacy/?ic=6047&sp_rid=NjI5OTAyNzU3NzAS1&sp_mid=9523061
4. Dumas, P. (2021) 7 Tips for Better Sex if You Have Migraine. Available [online] at: ://www.migraineagain.com/7-tips-for-better-sex-if-you-have-migraine/
5. Editorial team (2020) Headaches and Sex. Available [online] at: https://migraine.com/migraine-triggers/sexual-activity/
6. Gardner, A. (2020) Sex and Migraine Headaches. Available [online] at: https://www.webmd.com/migraines-headaches/features/migraines-and-sex