Migraine in Men Not Uncommon but Not Always Diagnosed

It is not uncommon for men to suffer migraines, but they are less likely than women with this condition to consult a doctor, and if they do, they are less likely to be diagnosed with migraine.

Those are some of the conclusions of a study on sex differences in migraine burden presented at the American Headache Society (AHS) 58th Annual Scientific Meeting.

“While migraine is more common in women than in men, it does afflict 6% of American men,” said Richard Lipton, MD, professor and vice chair of neurology, Albert Einstein College of Medicine, and director, Montefiore Headache Center, New York City.

“The myth that migraine is a women’s disease may contribute to the stigma of migraine and certainly denies men access to medical care.”
Dr Richard Lipton
Dr Lipton reminded physicians that migraine is “very common in men” and that men may be reluctant to talk about their headaches.

For this Chronic Migraine Epidemiology and Outcomes (CaMEO) study, participants with migraine completed a baseline survey and a second online survey 3 months later.
Researchers assessed sociodemographic information; headache features; headache-related disability, using the Migraine Disability Assessment Scale (MIDAS); symptom severity, as measured by the Migraine Symptom Severity Score; cutaneous allodynia, using the Allodynia Symptoms Checklist; and treatments.

Of the 16,789 respondents, 25.6% were men. The mean age of respondents was 42.0 years for men and 40.8 years for women.

The men reported fewer headache days per month than women (4.3 vs 5.3; P < .001).

MIDAS scores were generally lower in men (P < .001). Whereas 24.1% of women were in the highest MIDAS category, only 15.7% of men were in this category.

Higher MIDAS scores among women suggest that their migraines have a more severe impact on their daily life in areas such as time lost from work or school and social and leisure activities.

Sex hormones contribute to the increased incidence and severity of migraine in women, Dr Lipton noted.

“The risk of migraine in women increases with sexual maturation,” he said, adding that there may also be sex differences in symptom reporting.

Interestingly, migraine is more common in boys than girls before puberty. The risk “takes off” in women after the onset of the menstrual cycle, said Dr Lipton.

“But our major points are that migraine is common in men even though it is more common in women and that it is severe in men even though it is more severe in women.”

Significantly fewer men than women in the study reported allodynia (32.6% vs 49.7%; P < .001). Allodynia is defined as experiencing typically nonpainful stimuli ― for example, wearing a hat or laying your head on a pillow ― as painful during a migraine.

“Allodynia develops as a response to attack frequency and severity and is one of the pieces of evidence that migraine is worse in women,” commented Dr Lipton.

Men were less likely than women to report seeing a physician to manage their headaches (28.6% vs 31.1%; P < 0.01).

Although men generally seek medical care less often than women for a range of conditions, in the case of headaches, “the myth that migraine is a women’s disease may make men with migraine more reluctant to seek care,” said Dr Lipton.

If men in the study did consult a physician, they were less likely than women to receive a migraine diagnosis (59.2% vs 77.7%; P < .001), suggesting that migraine is underdiagnosed in men, said Dr Lipton.

As for treatment, 24.1% of men and 28.2% of women reported using prescription medications to treat headaches (P < .001). Men and women used prescription preventive treatments in a similar manner.

Benjamin W. Friedman, MD, associate professor of emergency medicine, Albert Einstein College of Medicine, who is a colleague of Dr Lipton’s but was not involved in the current study, commented on the findings for Medscape Medical News.

“It is interesting that there were both patient-related reasons (lower levels of consulting) and physician-related reasons (failure to diagnose) for men obtaining appropriate treatment for migraine less frequently,” Dr Friedman noted.

“Men do seem to experience migraine differently than women. This is reflected elsewhere in the medical literature,” he added. “Epidemiologically, even though men experience migraine less frequently than women, this is still a highly prevalent illness that affects hundreds of millions of men worldwide.”