A 37-year-old woman presented at the Neurology Outpatient Department with a history of complaints of headaches since the age of 10. Her attacks start with an aura of less than 1 hour, with unilateral flickering lights, followed by unilateral headache lasting between 12 and 24 hours. The headache is accompanied by nausea, vomiting, and photo- and phonophobia. The headache, fulfilling the criteria for Migraine With Aura of The International Headache Society, is aggravated by routine physical activities.2 For the last year, she reported three consecutive attacks every 3 weeks. Metoprolol, rizatriptan, and continuation of the oral contraception pill did not reduce the frequency and severity of the attacks. The physical and neurological examination was normal. The patient started on topiramate 50 mg/day as migraine prophylaxis. After 6 weeks of treatment and increase of dosage to 75 mg/day, she reported complaints of anorgasmia. Two weeks after dosage reduction to 50 mg/day, anorgasmia had disappeared, but the intensity of orgasm was still less than before taking topiramate. The patient had never experienced anorgasmia before. There was no loss of sexual desire, sexual arousal, sexual thoughts or fantasies, or lack of lubrication. Her headache was significantly reduced on topiramate 50 mg/day. She reported only one attack of migraine in the first 2 months of treatment. Because of the beneficial effects of topiramate on the frequency of migraine attacks, she decided to continue this treatment at a dosage of 50 mg/day despite the reduced intensity of orgasm feelings.