Migraine: Men Vs Women

Migraine: Men Vs Women

Cerebral Torque

Sex-Based Differences in Migraine

1. Epidemiology and Demographics

Parameter Men Women Clinical Implications References
Global Prevalence 15% of population 45% of population Sex difference emerges during puberty, suggesting hormonal influence on migraine susceptibility [1]
Lifetime Incidence 18% cumulative risk 48% cumulative risk 2.7x lower lifetime risk in men indicates fundamental biological differences in susceptibility [2]
Age-Related Patterns 2-5% (7-9 years)
4% (13-15 years)		 2-5% (7-9 years)
6.4% (13-15 years)		 Equal childhood prevalence suggests hormonal role in later divergence [3]

2. Clinical Presentation

Feature Men Women Clinical Implications References
Attack Duration Consistently shorter, even compared to postmenopausal women Longer attacks, particularly during menstruation Different acute treatment duration needs; suggests intrinsic sex differences beyond hormonal effects [4, 5]
Pain Intensity Lower VAS scores; higher pain tolerance; smaller functional responses to noxious stimuli Higher VAS scores; lower pain tolerance; larger functional responses Need for sex-specific pain assessment scales and treatment thresholds [6, 7, 8]
Associated Symptoms Less frequent nausea, photophobia, phonophobia, and allodynia More frequent and severe accompanying symptoms May affect diagnostic accuracy using current ICHD-3 criteria [9, 10, 11]

3. Biological Mechanisms

Mechanism Men Women Clinical Implications References
CGRP System 30% lower receptor expression; 40% lower basal CGRP release Higher receptor expression and basal release levels Affects response to CGRP-targeted therapies; may explain lower attack frequency in men [12, 13, 14]
Brain Structure Specific changes in parahippocampal gyrus volume Changes in posterior insula and precuneus Different pain processing pathways between sexes affect treatment response [15]
Hormonal Effects Testosterone provides protective effects through multiple mechanisms Cyclical hormonal variations affect migraine patterns Basis for sex-specific treatment approaches; suggests potential therapeutic targets [16, 17, 18]

4. Treatment Response

Aspect Men Women Clinical Implications References
Drug Clearance 20-30% faster due to higher enzymatic activity Slower clearance May require different dosing intervals [19]
Triptan Response 36% lower headache recurrence; better overall response Higher recurrence rates Affects acute treatment strategy and dosing [20]
CGRP Antagonists NNT = 36 NNT = 11 Significant difference in effectiveness by sex [21]

5. Healthcare Utilization

Aspect Men Women Clinical Implications References
Consultation Rates 40% less likely to seek care Higher consultation rates Need for targeted intervention strategies in male patients [22]
Diagnostic Patterns Often delayed diagnosis; less likely to receive diagnosis Earlier diagnosis typical Risk of underdiagnosis in male population [23]
Impact Reporting Less likely to report disability More complete impact reporting May affect disability assessment accuracy [23]

References

  1. Ashina M et al (2021) Migraine: epidemiology and systems of care. Lancet 397(10283):1485-1495
  2. Stewart WF et al (2008) Cumulative lifetime migraine incidence in women and men. Cephalalgia 28(11):1170-1178
  3. Victor TW et al (2010) Migraine prevalence by age and sex in the United States: a life-span study. Cephalalgia 30(9):1065-1072
  4. Kelman L (2006) Pain characteristics of the Acute Migraine Attack. Headache: J Head Face Pain 46(6):942-953
  5. Steiner TJ et al (2003) The prevalence and disability burden of adult migraine in England and their relationships to Age, gender and ethnicity. Cephalalgia 23(7):519-527
  6. Klatzkin RR, Mechlin B, Girdler SS (2010) Menstrual cycle phase does not influence gender differences in experimental pain sensitivity. Eur J Pain 14(1):77-82
  7. Riley JL et al (1998) Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain 74(2):181-187
  8. Jiménez-Trujillo I et al (2019) Gender differences in the prevalence and characteristics of Pain in Spain: Report from a Population-based study. Pain Med 20(12):2349-2359
  9. Song TJ et al (2019) Sex differences in prevalence, symptoms, impact, and psychiatric comorbidities in migraine and probable migraine: a population-based study. Headache 59(2):215-223
  10. Louter MA et al (2013) Cutaneous allodynia as a predictor of migraine chronification. Brain 136(11):3489-3496
  11. Güven H et al (2013) Cutaneous allodynia in patients with episodic migraine. Neurol Sci 34(8):1397-1402
  12. Stucky NL et al (2011) Sex differences in behavior and expression of CGRP-related genes in a rodent model of chronic migraine. Headache 51(5):674-692
  13. Maddahi A et al (2023) Progesterone distribution in the trigeminal system and its role to modulate sensory neurotransmission: influence of sex. J Headache Pain 24(1):154
  14. Ji Y et al (2019) Sex differences in the expression of calcitonin gene-related peptide receptor components in the spinal trigeminal nucleus. Neurobiol Pain 6:100031
  15. Maleki N et al (2012) Her versus his migraine: multiple sex differences in brain function and structure. Brain 135(8):2546-2559
  16. Eikermann-Haerter K et al (2009) Androgenic suppression of spreading depression in familial hemiplegic migraine type 1 mutant mice. Ann Neurol 66(4):564-568
  17. Eikermann-Haerter K et al (2009) Genetic and hormonal factors modulate spreading depression and transient hemiparesis in mouse models of familial hemiplegic migraine type 1. J Clin Invest 119(1):99-109
  18. Labastida-Ramírez A et al (2019) Gender aspects of CGRP in migraine. Cephalalgia 39(3):435-444
  19. Soldin OP, Mattison DR (2009) Sex differences in pharmacokinetics and pharmacodynamics. Clin Pharmacokinet 48(3):143-157
  20. van Casteren DS et al (2021) Sex differences in response to triptans. Neurology 96(4):162-170
  21. Porreca F et al (2024) Evaluation of outcomes of calcitonin gene-related peptide (CGRP)-targeting therapies for acute and preventive migraine treatment based on patient sex. Cephalalgia 44(3):3331024241238153
  22. Brusa P et al (2015) Migraine attacks in the pharmacy: a gender subanalysis on treatment preferences. Neurol Sci 36(S1):93-95
  23. Buse DC et al (2013) Sex differences in the prevalence, symptoms, and associated features of migraine, probable migraine and other severe headache: results of the american migraine prevalence and prevention (AMPP) study. Headache 53(8):1278-1299
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