Conference Coverage
SAN DIEGO—Men with migraine have fewer headache days per month, less disability, and less allodynia than women with migraine, according to research presented at the 58th Annual Scientific Meeting of the American Headache Society. “Nonetheless, migraine is disabling in men,” and physicians may be less likely to recognize migraine in men than in women, said Ann I. Scher, PhD, Professor of Preventive Medicine and Biostatistics and affiliated with Uniformed Services University of the Health Sciences in Bethesda, Maryland. In addition, men who have episodic migraine are more likely to transition from episodic to chronic migraine over one year of follow-up than women, she said.
Ann I. Scher, PhD
Despite the fact that migraine may be the most common neurologic condition in men, “the perception that migraine is a woman’s disease may contribute to migraine stigma and deny men access to diagnosis and treatment,” Dr. Scher said.
To assess sex differences in migraine, Dr. Scher and colleagues analyzed data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Participants completed validated online questionnaires and were broadly representative of the United States population’s demographic characteristics. Questionnaires assessed sociodemographics, headache features, headache-related disability, symptom severity, cutaneous allodynia, and treatment.
A More Severe Phenotype
The researchers included in their analysis 16,789 respondents who met modified International Classification of Headache Disorders, 3rd edition beta migraine criteria. Of the participants with migraine, 4,294 (25.6%) were men, and 12,495 (74.4%) were women. Compared with women, men were slightly older at enrollment (42.0 vs 40.8). Men and women with migraine were equally likely to be currently employed.
Women had about one more headache day per month than men (five vs four). Migraine Disability Assessment Scale (MIDAS) scores were generally lower in men than in women. For example, 15.7% of men were in the highest MIDAS disability category, compared with 24.1% of women. Significantly fewer men than women reported allodynia (32.6% vs 49.7%). A smaller proportion of men than women had chronic migraine, defined as 15 or more headache days per month (6.5% vs 9.6%). “Generally, women had a more severe phenotype than men,” Dr. Scher said.
Treatment Patterns
Men were slightly less likely than women to report currently seeing a doctor to manage their headaches (28.6% vs 31.1%). “What was striking, among those who did consult with a physician, the women were considerably more likely to receive a diagnosis of migraine,” Dr. Scher said. Researchers found that 59.2% of men received a diagnosis of migraine, compared with 77.7% of women.
Men were less likely than women to use prescription medication for headache (24.1% vs 28.2%), including acute prescription medications (16.5% vs 22.0%). About 12% of men and women used prescription preventives.
In the CaMEO study, participants completed questionnaires at baseline and at three, six, nine, and 12 months, and headache frequency was measured at each time point. Compared with women, men were at increased risk of converting to chronic migraine at all time points. This finding persisted after adjustment for various factors, including BMI, headache frequency, depression, and anxiety, Dr. Scher said. The magnitude of the hazard ratio varied at each time, however, and the researchers still are trying to determine the best way to assess the risk of converting to chronic migraine, Dr. Scher said.
The CaMEO study was funded by Allergan.
—Jake Remaly
