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Has anyone experienced terrible migraines when starting tadalafil? I really need to take this medication but the migraines are debilitating.

A myPHteam Member asked a question 💭
Naples, FL

I recently started on tadalafil, and I've only been able to take five doses, and that was with powering through the worst migraine I've had in a long time. It was so bad that I ended up having to go to the ER to be given IV migraine medications. I was started on the standard 20mg dose with a planned increase soon, but I haven't been able to tolerate the tadalafil. I'm just wondering if anyone else is sensitive to this medication?

November 13, 2025
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A myPHteam Member

Thanks so much for all the advice and the information! ❤️

November 15, 2025
A myPHteam Member

Tadalafil gave me a 24/7 cough which is a rare side effect from it. I’ve read that severe headaches is a more common side effect.

You may want to ask your doctor if you can switch to Adempas.

November 13, 2025
A myPHteam Member

You are better off getting Opsumit and Adempas separately. Easier to monitor any side effects than if you are on a combo pill.

I was switched to Adempas when I couldn’t handle Tadalafil. Then I was taken off Adempas when I was reclassified as Group 2.

November 14, 2025
A myPHteam Member

Thanks that's actually a great idea! Did they have to switch you over to Adempas? I know the ultimate goal is to have me on the opsumit/tadalafil combo medication but at this rate I might not be able to get there as quickly as they had hoped.

November 14, 2025
myPHteam

Has anyone experienced terrible migraines when starting tadalafil?

Yes, headaches are a very common side effect of tadalafil and other phosphodiesterase type 5 (PDE5) inhibitors used to treat pulmonary hypertension. These medications work by dilating blood vessels to reduce blood pressure in the pulmonary arteries, which Show Full Answer

Has anyone experienced terrible migraines when starting tadalafil?

Yes, headaches are a very common side effect of tadalafil and other phosphodiesterase type 5 (PDE5) inhibitors used to treat pulmonary hypertension. These medications work by dilating blood vessels to reduce blood pressure in the pulmonary arteries, which can lead to headaches as a side effect.

The severity you're experiencing—requiring ER treatment with IV migraine medications—is concerning and definitely worth discussing with your doctor right away. While headaches are expected with tadalafil, debilitating migraines that interfere with your ability to take the medication need medical attention. Your doctor may consider several approaches:

- Starting with a lower dose and gradually increasing it to help your body adjust
- Trying preventive headache management strategies
- Exploring alternative PH medications if the migraines don't improve

Don't try to power through this level of pain. Your healthcare team needs to know about this severe reaction so they can adjust your treatment plan. Some people do become more tolerant of headache side effects over time, but that severe of a reaction warrants immediate medical guidance about whether to continue or modify your approach.

November 13, 2025

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