Study: Migraines in men are rarer, but more severe and still stigmatized

Although migraines affect women three times more often, men suffer more from them, seek help less often, and are more likely to overuse medications, according to the nationwide study "Migraine in Poland." The latest analysis of the results focused exclusively on men.

"Contrary to popular belief that migraines are a female disease, they also affect men, in whom the symptoms may be more severe. Men see doctors less often and later, they abuse over-the-counter medications and – interestingly – supplements, their attacks last longer and more often lead to chronic disease. Furthermore, men feel stigmatized and embarrassed," the study's lead author, neurologist Dr. Marta Waliszewska-Prosół from the Department of Neurology, Medical University of Wrocław, told PAP.

Together with her team, she conducted the largest analysis to date of migraine in the Polish population. The project involved over 3,200 people (including 599 men) aged 13 to 80, conducted via an online survey. The collected responses were used to assess gender differences in the course of the disease, treatment methods, and healthcare utilization.

The study results were published in The Journal of Headache and Pain .

As Dr. Waliszewska-Prosół emphasized, the topic of male migraine is marginalized in the global scientific literature. "In the vast majority of observational and clinical studies, the study group is 80-90% composed of women. Men are usually an irrelevant comparator, not included in comparative analyses, and the studies themselves focus solely on the female perspective. Therefore, there is a huge gap in knowledge about the course of the disease in men, and they themselves remain very poorly cared for by the healthcare system. We hope that our analysis will change this and draw attention to men suffering from migraine," she emphasized.

The results showed that men are less likely than women to report visual and sensory aura symptoms during migraine, but they are more likely to report other symptoms preceding the attack (prodromal), such as anxiety, fatigue, or irritability. The postictal phase, or the time it takes to return to normal functioning after a migraine attack, is significantly longer in men – an average of 24 hours, compared to 10 hours in women.

"This means that attacks in men are longer and often more severe, which was somewhat surprising to us, as this hasn't been reported before. It's very rare, even in doctors' offices, to hear men directly complaining about headaches and the symptoms accompanying attacks that so significantly impede their daily functioning," the neurologist noted.

The study revealed that men were significantly more likely to use medication during attacks, but significantly less likely to use preventative treatment. Over 80% of men used prescribed painkillers (compared to 69% of women), 77% used over-the-counter medications (52% of women), and 43% used natural or alternative remedies (15% of women). Only 21% of men used preventative treatment for migraines, compared to 38% of women.

Alarmingly, nearly 30% of men met the criteria for painkiller abuse, compared to 22% of women. "However, they can't be blamed for this. Many of them haven't received any treatment beyond another painkiller for years. Our respondents were surprised that there are medications that can be taken regularly to prevent attacks and, above all, that migraines can be treated," noted Dr. Waliszewska-Prosół.

Men also declared twice as high monthly expenses on medicines - PLN 200 compared to PLN 100 for women.

Chronic migraine was diagnosed significantly more often in men (10% compared to 6.5% in women). This is the most difficult form of migraine to treat, diagnosed when headaches occur for at least 15 days per month, including at least eight days with migraine, and the condition persists for three months or longer. However, as Dr. Waliszewska-Prosół pointed out, 15 days is only a conventional limit – most often, a patient with chronic migraine has 20, 25, or even 30 days with headaches each month.

"In men, we observe a more rapid progression from episodic to chronic migraine, known as chronicity. Besides the risk factors common to both sexes, this also results from, among other things, years of neglecting the disease and lack of proper treatment," she pointed out.

Gender differences are also evident in mental health issues and the impact of migraines on daily functioning. In women, migraines are more likely to lead to depressive disorders and the abandonment of household chores and social gatherings. Men, on the other hand, are more likely to miss work due to migraines and are less productive at work.

According to Dr. Waliszewska-Prosół, one of the most important conclusions from the study is that migraine in men differs from that in women not only in terms of its course and prognosis, but also in social determinants.

"Men are ashamed of their illness, which stems from stereotypical perceptions of masculinity, which leave no room for weakness, such as headaches. After all, 'the condition of upper-class women and a headache' can't apply to men. Therefore, men often come to the doctor's office after many years, when they can no longer cope with everyday life. And then their treatment is a much greater challenge, because on the one hand, the disease is advanced and the brain functions differently, and on the other, there is often the problem of overusing painkillers, which intensifies the vicious cycle of pain," admitted the study's author.

She noted that the situation is further complicated by how migraines are perceived by some doctors. "Sometimes they're downplayed, called an ailment, a 'beauty thing,' rather than a disease. The patient is told to take a pill and sent home. When a man hears something like that, he won't come back, precisely for psychosocial reasons. Women are more determined, so they don't stop searching and keep knocking on the doors of other specialists. This may be the reason for the differences in treatment we observed," the researcher explained.

In her opinion, migraine is a disease marginalized in both genders (both by the system and by decision-makers), which should be emphasized and efforts should be made to change it. However, in the case of men, it is met with even less understanding and acceptance. "There is still a lack of awareness that it is a chronic, neurological disease requiring systemic treatment. Until the entire medical community speaks about it in this way, society will not change its approach," she said.

- And let us remember that in Poland up to 6 million people may suffer from migraines - she added.

Therefore, she believes educational efforts are necessary, especially aimed at men, to reduce the stigma surrounding the disease and accelerate the implementation of appropriate treatment. "It's also worth continuing studies like ours to determine whether the different course of the disease in both sexes should also influence treatment decisions," she said.

"I'd like our work to stop people from thinking of migraines as a women's disease. This is untrue, because migraines affect both sexes. And although women get sick more often, men often suffer more severely," the expert concluded.

Katarzyna Czechowicz (PAP)

kap/ agt/ ktl/