Migraine: Men Vs Women
Cerebral TorqueShare
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
- Ashina M et al (2021) Migraine: epidemiology and systems of care. Lancet 397(10283):1485-1495
- Stewart WF et al (2008) Cumulative lifetime migraine incidence in women and men. Cephalalgia 28(11):1170-1178
- Victor TW et al (2010) Migraine prevalence by age and sex in the United States: a life-span study. Cephalalgia 30(9):1065-1072
- Kelman L (2006) Pain characteristics of the Acute Migraine Attack. Headache: J Head Face Pain 46(6):942-953
- 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
- 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
- Riley JL et al (1998) Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain 74(2):181-187
- 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
- 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
- Louter MA et al (2013) Cutaneous allodynia as a predictor of migraine chronification. Brain 136(11):3489-3496
- Güven H et al (2013) Cutaneous allodynia in patients with episodic migraine. Neurol Sci 34(8):1397-1402
- 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
- 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
- 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
- Maleki N et al (2012) Her versus his migraine: multiple sex differences in brain function and structure. Brain 135(8):2546-2559
- 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
- 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
- Labastida-Ramírez A et al (2019) Gender aspects of CGRP in migraine. Cephalalgia 39(3):435-444
- Soldin OP, Mattison DR (2009) Sex differences in pharmacokinetics and pharmacodynamics. Clin Pharmacokinet 48(3):143-157
- van Casteren DS et al (2021) Sex differences in response to triptans. Neurology 96(4):162-170
- 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
- Brusa P et al (2015) Migraine attacks in the pharmacy: a gender subanalysis on treatment preferences. Neurol Sci 36(S1):93-95
- 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
