Outside of my immediate family, I rarely see a man complain about migraine. And — speaking purely anecdotally, of course — of the few men I know who do experience migraine, it seems they encounter it less often and the episodes are less intense, rarely interfering with their lives.
Is this because migraine I experience, personably, is so much worse? Or is there more to it?
I looked at the research and what I found was eye-opening. Migraine affects about one billion people worldwide. However, the majority of those experiencing migraine are women. In fact, a 2014 study found women are three times more likely than men to experience migraine.
The study also found that women experience migraine differently than men, in every way. Females are more likely to experience the full variety of symptoms associated with migraine, are more likely to seek out treatment, and are more likely to use prescription medications to treat migraine.
Migraine more often interferes with life, both socially and professionally, for women.
Know the symptoms
Females are more likely to report the variety of symptoms associated with migraine, including nausea, vomiting, visual aura, throbbing or pulsing pain on one side of the head, blurred vision, and sensitivity to light and sound.
While men and women report similar levels of pain severity, females are more likely to experience migraine-related disability. Females are more likely to require bedrest during a migraine. Females are also more likely to report that migraines interfere with their ability to do housework or interact socially at least one day a month.
What's the frequency?
The frequency of migraine varies only slightly between the sexes. Men and women report an average of between one and four migraine per month. Males are more likely to experience migraine rarely (less than one a month) or at almost chronic levels, i.e., greater than 10 per month.
Gauging the impact
Men generally report that migraine does not affect their ability to work or interact socially. Females, on the other hand, report that migraine affects their ability to work by at least 50 percent one day a month and prohibits them from interacting socially at least one day a month.
Females also report that it often takes them several days to fully recover from a migraine attack, while males generally report being affected for less than a day.
Females are more likely to seek out treatment for migraine, which may explain the increased use of prescription medications. They are more likely to take anything, including over-the-counter or prescription medications. They are also much more likely to have visited the emergency room or urgent care due to a migraine attack.
When males do take something, they are more likely to treat migraine attacks with over-the-counter medications. Similarly, males are slightly less likely to take preventative migraine medications.
Why does the experience differ so dramatically?
Do women really experience worse migraine? Or are they just more likely to report symptoms and seek care?
One theory for the increased prevalence of migraine, and worsened experience, among females revolves around hormones. A small 2018 study found that men who experience migraine have higher levels of the female hormone estradiol and are more likely to suffer from androgen deficiency. Similarly, studies have shown that menstrual migraine includes worsened symptoms and is associated with greater disability. This may explain why women are more likely to report at least one migraine episode per month.
Other studies point out structural and functional brain differences between females with migraine and 1) males with migraine and 2) healthy people of both sexes.
Researchers believe that differences in gender and social roles, coping skills, and psychological makeup could explain how migraine impacts the sexes differently. Women historically have more household responsibilities than males and may feel a stronger responsibility to fulfill those activities despite illness. Social-activity differences are harder to explain, but again, it is possible that males are less likely to feel responsible to fulfill social activities. Or perhaps women engage in more social activities.
Diagnosis is not likely without consulting a physician. As males are generally less likely to seek out medical treatment, this may partially explain why males are less likely to be diagnosed with migraine.
We all experience migraine differently, regardless of sex. One person’s symptoms are not the same as another's, but that doesn’t mean that their experience is any less painful. Just because males and females experience migraine differently doesn’t mean that either should be dismissed. Perhaps as gender roles continue to evolve, we will see that the differences aren't so vast, after all.