Skip to main content

Verified by Psychology Today


Young Men’s Greatest Risk Factor for Erection Problems

Migraine headache is young men's top risk factor for erectile dysfunction (ED).

Key points

  • The leading risk factor for ED in young men isn't stress, alcohol, smoking, obesity, diabetes, or depression.
  • Migraines cause searing pain that ruins sex.
  • With help from headache specialists, migraines can be managed effectively.

Young men’s top risk factor for erectile dysfunction (ED) is migraine headaches. Compared with men who don’t suffer migraines, men under 40 who do are an astonishing 32 times more likely to experience ED. For men in this age group, migraines are the number-one risk factor for ED.

This surprising finding comes not from any single nonreplicated study, but from an analysis—technically, a meta-analysis—of six studies in five countries that included 51,657 participants, 6,175 of whom had migraines. That’s a huge sample, which lends tremendous credence to the findings. In men of all ages, the migraine sufferers were 60 percent more likely to report erectile dysfunction. But the risk for men under 40 was 32 times—3,200 percent—greater than average.

Few doctors, sex therapists, and sexologists—including yours truly—have appreciated the migraine-ED connection. A few years ago, I blogged about 22 well-documented risk factors for ED. Migraine was not among them. None of the studies in the meta-analysis generated headlines, so they remained obscure. But the new analysis should change that. Migraines are a significant risk factor for ED in men of all ages. But in men under 40, they’re number one.

Meta-Analyses Explained

It’s very expensive to conduct medical research, especially with human subjects. In addition, as the number of subjects increases, so does the cost. As a result, most studies rely on small numbers of participants. But small samples produce findings that may be erroneous. The larger the sample, the more likely the results are to be true. In 1976, University of Colorado professor of statistics Gene Glass developed statistical tools that allowed the results of several small studies to be mathematically combined as though they’d all been part of one much larger study. He dubbed his approach “meta-analysis.” Over the past four decades, meta-analysis has become a standard approach to teasing the truth out of small trials that may have conflicting findings.

In the ED-migraine meta-analysis, Chinese researchers combined the results of two studies from China, two from the United States, and one each from Spain, Turkey, and India. Their samples ranged in size from 60 men to 20,000. Combining all the participants produced a total sample of 51,657 participants, 6,175 of whom had migraines. In medical research, those are enormous numbers that greatly increase the credibility of the findings.

Why a Migraine-ED Link?

The main reason migraines are linked to ED is pain. Migraines cause searing headaches. When people suffer severe pain, their libidos and sexual function plummet. Indeed, in the studies feeding the meta-analysis, as the frequency and severity of migraines increased, so did the risk of ED.

In addition, migraines often cause anxiety and depressionfear that they’ll strike again soon and misery, helplessness, and hopelessness when they do. Anxiety and depression are both risk factors for ED.

Migraines also reduce quality of life, another contributor to sex problems.

Finally, compelling research shows that migraines are linked to an increased risk of heart disease, which is a leading contributor to ED. Heart disease narrows the arteries that carry blood into the penis. Narrowed arteries mean less blood available to raise erections. And heart disease reduces the body’s release of nitric oxide, a compound that plays a key role in enabling erection.

ED Risk Factors Compared

Diabetes and lack of exercise (particularly five or more daily hours of screen time) triple risk for ED. They raise risk 300 percent. Smoking, obesity, heart disease, and migraines in men over 40 raise risk by approximately 60 percent, and depression about 40 percent. But migraines in men under 40 spike risk much more—3200 percent.

Migraines are often considered a woman’s affliction. The lifetime risk for women is 33 percent; for men, it is only 13 percent. Consequently, the impact of migraines on men has been understudied.

According to the International Headache Society, there are 129 different types of headache, but the three most common are migraine (accounting for 30 percent of headache-related doctor visits), tension headache (47 percent), and sinus headaches, related to sinus infection or hayfever-type allergies (6 percent).

Migraines cause severe pounding, throbbing pain usually on one side of the head, and are often accompanied by nausea and vomiting. Frequently, they strike in the morning and last from a few hours to two days. Some poor souls get migraines almost daily. Others experience them every few weeks or months. Most migraine sufferers get two to five a month. From 15 minutes to an hour before migraines strike, some 20 percent of people experience strange symptoms such as flashing lights, blurred vision, blind spots, or peculiar smells (auras).

Migraines tend to run in families, though no clear genetic link has been established.

Migraines usually begin in childhood or during the teen years and are strongly associated with motion sickness. Migraines typically peak around age 35 and gradually decline after that, one of the great blessings of aging.

It’s not entirely clear what causes migraines, but one culprit is the blood vessels in the head. They constrict and expand (dilate) in response to foods, moods, hormones, drugs—all sorts of things. If pain nerves near those vessels are sensitive to these changes, the result is migraines.

How to Cope

If you’re a man who suffers migraines, you are not fated to develop ED. Migraine is a risk factor for ED, not a certainty.

Anyone with migraines should be under a physician’s care. If you suffer frequent or severe migraines, consider consulting a doctor who’s a member of the American Migraine Foundation.

If you suffer migraines and develop ED, think twice before using erection medications. The major erection drugs—Viagra, Cialis, Levitra, and a few others—are all phosphodiesterase-5 inhibitors. Some studies show that these drugs may trigger migraines.

If you’re a couples or sex therapist and a man under 40 consults you for ED, be sure to ask if he suffers migraines.


Aksoy, D et al. “The Evaluation of Sexual Dysfunction in Male Patients with Migraine and Tension-Type Headache,” Journal of Headache Pain (2-13) 14:46.

Evans, RW and C Kruuse. “Phosphodiesterase-5 Inhibitors and Migraine,” Headache (2004) 44:925.

Nemichandra, SC et al. “Erectile Dysfunction in Migraine in Indian Patients,” Annals of the Indian Academy of Neurology (2020) 23:792.

Welcheng, H et al. “Migraine is Associated with High Risk of Erectile Dysfunction: A Systematic Review and Cumulative Analysis,” Journal of Sexual Medicine (2022) 19:430. Doi: 10.1016/jsxm.2021.12.014.

More from Michael Castleman M.A.
More from Psychology Today