Migraine in Men: Underestimated and Undertreated

Migraine in Men: Underestimated and Undertreated 

Migraine is often labeled a "women's disease,' and it’s true that migraine is more common in women than men. The fact that men can get migraines too — and that these can take a serious toll on their well-being — is something that tends to fly under the public radar. What does the research say about 'men’s migraine'? Does migraine manifest differently in men, and if so, why might that be?

The ‘affect gap’ between women and men

All the statistics on migraine burden show that women get migraines more often than men. Studies have shown that the ‘affect gap’ begins to open at the onset of puberty, when girls are between 13 and 15 years old. As hormone levels rise, migraine prevalence among girls increases significantly compared to boys. This divergence in prevalence between male and female patients peaks at around the age of 30.

Does migraine look different in men?

Studies have also shown that beyond frequency, the clinical presentation of the disease differs between men and women. Attack frequency and duration, perceived pain intensity, the overall migraine burden, and associated health symptoms all vary. Even the effectiveness of pharmacological treatments can differ between men and women.

The underlying reasons for all these differences remain poorly understood. In addition to known hormonal disparities between the sexes, other factors likely also play a role. Researchers now even suspect that fundamentally different biological pathways may govern migraine development in men and women. There is significantly more scientific research on the specific migraine burden in women, especially regarding its causes, effects, and associated burdens. This has led to a 'knowledge gap' in addition to the 'affect gap' between male and female migraine patients. However, the emergence of personalized medicine is beginning to close this gap on the research front. This is all the more important as sex differences are increasingly recognized and taken into account across many areas of medical research.

Do men have migraines less often than women?

The research published in scientific journals is inconsistent when it comes to differences in attack frequency between the sexes. A study from Korea, for instance, found no gender differences in attack frequency. Similarly, a Dutch study showed roughly equal numbers of monthly migraine days up to the age of 50. A Danish study reached different conclusions, finding that women experienced both more frequent migraine headaches and more intense pain. Moreover, symptoms associated with aura were more pronounced in females than in males. The burden of disease was found to be particularly high among women with aura.

In most available studies, the intensity of pain during a migraine attack was rated significantly more severe by women than by men. Men appear to have a higher pain threshold and tolerance, which may explain the lower pain levels reported by males.

Hermeneutic challenges: a common problem in migraine studies

Some contradictions in scientific findings may stem from differences in study methodology (e.g., interviews, questionnaires, online surveys, or apps). Moreover, despite advanced techniques, it’s not always possible to completely separate hormonally triggered headache attacks from general migraine statistics.  

Despite these interpretive challenges, some well-documented gender differences have emerged. Men were much less likely to experience dizziness, nausea, and vomiting than women, for instance. They were also less frequently and less severely affected by sensitivity to noise and smells (phonophobia and osmophobia).

Despite these differences, it must be acknowledged that the burden of migraine can be significant for men and should be taken seriously as a health issue—not least by the affected men themselves. More about that later.

Are there migraine-associated comorbidities that are more common in men?

Migraine is often accompanied by other illnesses, which increases the disease burden on patients. Physical conditions such as cardiovascular symptoms, asthma, or allergies are commonly observed. Migraine is also frequently associated with mental health disorders, with depression and anxiety disorders being common. Chronic fatigue syndrome (CFS) is another condition often seen alongside migraine.

There is a notable lack of research publications on comorbidities in male migraine patients compared to papers focusing on women. It seems to be the case that men are a little less likely than women to have other medical conditions alongside their migraine. Any comorbidities men do have tend to be different from those seen in women. Coronary artery narrowing and other cardiovascular problems are more common in men, for example. Male migraineurs also face an increased risk of stroke, especially when aura symptoms are present. Men are also more likely to be diagnosed with kidney stones.

When comparing comorbidities across genders, a clear picture emerges: men with migraine are more likely to struggle with physical ailments, whereas women are more frequently affected by mental health issues and psychosomatic disorders. According to scientists, this definite imbalance poses a risk that mental health conditions in men may be overlooked.

Are there male-specific migraine triggers?

A number of migraine triggers are known to affect both sexes equally: stress, fasting, and sleep deprivation. Overall, men seem to have fewer migraine triggers than women — or at least, fewer have been identified so far. However, some studies suggest that certain triggers are especially likely to provoke an attack in male migraine sufferers. In addition to alcohol and intense physical exertion, too much sleep — basically the opposite of sleep deprivation, which triggers migraines in both sexes — has been identified as a trigger for men. All in all, the relevance of specific triggers in men appears to be roughly similar to the levels seen in postmenopausal women.

Migraine in men: underestimated, ignored, underdiagnosed

Although men are significantly less likely to develop migraine than women, the risk is by no means zero. Nonetheless, migraine is very rarely diagnosed in men. The 'women’s disease' label means that potentially affected men and their doctors may overlook the possibility of migraine. Added to this is the fact that men in general are less likely than women to seek medical advice, even for chronic conditions. Migraine is also still often associated with social stigma, manifesting in labels such as 'overly sensitive,'poor performer’ or 'malingerer'. (For more about migraine stigma, read this article.) Such attributions challenge men’s sense of masculinity, leading them to deny their condition both to themselves and others—even when the impacts are significant and undeniable.

These circumstances make it much harder for male migraine sufferers to take their condition seriously, receive an accurate diagnosis, and take action to manage their illness. There is an urgent need for better education, both to help patients better understand themselves and to improve societal acceptance. Increased awareness will help more people receive an accurate diagnosis and sustainable treatment.