Since recent findings suggested high sexual desire in migraineurs, we clinically evaluated the relationship between sexual behaviour and analgesic intake in patients with episodic migraine. Subjects and methods. 130 patients with episodic migraine and 60 sex and age matched subjects with episodic tension-type headache (TTH) participated in the study. After three diagnostic interviews, an expert sexologist administered Sexual Desire Inventory (SDI), Sexual Addiction Screening Test (SAST), Leeds Dependence Questionnaire (LDQ), Beck Depression Inventory (BDI) and Zung Self-rating Anxiety Scale (SAS). Results. Migraineurs reported higher SDI score than TTH (F = 4.62, P < 0.000) with a gender significant difference consisting in major dyadic desire for women (F = 5.72, P < 0.001) and solitary desire for men (F = 5.93, P < 0.001). Migraineurs reported higher score of LDQ and SAST than TTH (F = 6.52, P < 0.005; F = 5.58, P < 0.001) with a significant direct correlation between SDI and LDQ (r = 0.87, P < 0.0001), SAST and LDQ (r = 0.91, P < 0.0001), BDI and SDI (r = 0.76, P = 0.000) and BDI and LDQ (r = 0,75, P < 0.001). Discussion. Since recent findings from functional neuroimaging suggest a role of prefrontal systems in both sexual and drug addiction, depressive symptoms and both sexual behaviour and medication dependency in migraine may represent a seeking reward dysfunction, sharing a dysregulation of serotonergic and dopaminergic projections to frontal structures.