Migraine in Men: Underestimated and Unspoken

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 once puberty begins, much more girls get migraine attacks than boys. As hormone levels rise, girls also get attacks much more frequently than boys. This divergence in prevalence between male and female patients peaks at around the age of 30.

Does migraine look different in men?

Investigations have also shown that beyond frequency, the clinical presentation of the disease differs between men and women. Mainly, the number and duration of attacks and pain intensity are different. The overall impact of migraine and the related health problems are also different between men and women. Medicines for treating migraine may work differently in each sex as well. The reasons for these differences are still not well 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 research into how migraine affects women — especially when it comes to how the condition develops, what effects it has, and the burdens it causes. This has led to a ‘knowledge gap’ in addition to the ‘affect gap’ between women’s migraine and men’s migraine. However, the emergence of ‘personalized medicine’ is beginning to close this gap in research activity. 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. One study from Korea found no difference in how often men and women get migraine attacks. A Dutch study also showed that, up to the age of 50, men and women had about the same number of migraine days per month. A Danish study reached different conclusions. It found that women had migraine attacks more often than men, with more severe pain. Moreover, symptoms associated with aura were more pronounced in females than in males. The perceived burden of disease was found to be particularly high in female patients with aura.

In most available studies, the intensity of pain during a migraine attack was rated significantly more severe by women than by men. The intensity and duration of pain that is still considered bearable (known as ‘pain tolerance’) seems to be slightly higher in male patients. The same applies to the point at which pain is first perceived, known as the pain threshold. These factors could help explain why men and women experience pain differently.

The comparability challenge: a common problem in migraine studies

Some contradictions in scientific results may stem from the use of different research methods (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 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 affected by increased sensitivity to noise and smells (phonophobia and osmophobia).

However, it needs to be acknowledged that migraine can be just as burdensome for men. It should be taken seriously as a health issue, especially by the patients themselves. More about that later.

Are there male-specific migraine comorbidities?

Migraine is often accompanied by other illnesses (known as ‘comorbidities’, which increases the 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 are far fewer studies on comorbidities in male migraine patients compared to those focusing on women. What seems to be emerging is that men are a little less likely than women to have a medical condition that comes with their migraine. When this does happen, it is usually a different condition than those seen in women. Coronary artery narrowing and other cardiovascular problems are more common in men, for instance. This group of patients also has an increased of having a stroke. The presence of an aura appears to further raise this risk. Men are also more likely to be diagnosed with kidney stones.

When comparing comorbidities across genders, a clear picture emerges: Men with migraine struggle more with physical symptoms, while women are more likely to have mental health issues. Mental health problems that show up as physical symptoms (known as ‘psychosomatic’ conditions) are also more common in women. 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 lack of sleep are among them. Overall, men seem to have fewer migraine triggers than women — or at least, fewer have been identified so far. However, there are also triggers that fairly predictably cause or worsen attacks 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. Overall, the relevance of specific triggers in men seems to be roughly similar to the levels seen in women after menopause.

Migraine in men: underestimated, unspoken, undiscovered

Although men are significantly less likely to develop migraine than women, the risk is by no means zero. However, the diagnosis is rarely made in men. The ‘women’s disease’ label means that potentially affected men and their doctors may overlook the possibility of migraine. Another issue is that men generally seek medical advice less often than women—even for chronic conditions. Migraine is still seen as shameful, with a stigma attached to it. People are quick to label migraine sufferers as “oversensitive’, ‘poor performers’, or “malingerers.” (For more about the prejudices migraine sufferers face, read this article.) Men with migraine may see their masculinity under attack. As a result, they may have difficulty admitting to themselves and others that they have a significant medical condition.

These circumstances make it much harder for men with migraine to take their suffering seriously, receive an accurate diagnosis, and take action to manage their illness. Education is badly needed in this area. People need to better understand their condition, and society needs to stop being judgmental. This would help ensure a proper diagnosis and effective treatment for as many patients as possible.