Migraine, a prevalent neurological disorder affecting millions globally, is often underdiagnosed and undertreated, particularly in its early stages. A recent study from the Headache Center of Charité – Universitätsmedizin Berlin sheds light on sex-related disparities in migraine recognition and management, revealing significant differences in how men and women experience and are treated for this debilitating condition.
The study, conducted between December 2015 and January 2023, analyzed data from 1,130 patients, highlighting that men were significantly less likely than women to receive a migraine diagnosis before referral to a tertiary headache center. While 73.8% of women had been diagnosed with migraine prior to their tertiary evaluation, only 57.0% of men had received the same diagnosis.
Understanding the Disparities
The findings point to a critical gap in clinical awareness that may contribute to persistent underdiagnosis and delayed treatment in men. Men reported lower pain intensity and shorter attack durations, whereas women more frequently experienced unilateral headaches, nausea, vomiting, photophobia, and osmophobia. These canonical migraine features in women facilitated recognition, whereas non-prototypical symptoms in men often led to missed diagnoses.
“Men with migraine are substantially less likely than women to receive an accurate diagnosis in routine care,” the study concludes, emphasizing the need for increased clinical awareness.
Clinical Implications and Expert Insights
Dr. Maria Schneider, a neurologist specializing in headache disorders, notes, “The misconception of migraine as a ‘women’s disorder’ may lead to biases in diagnosis and treatment. Men often present with less typical symptoms, which can be overlooked by clinicians.”
Schneider’s observations align with the study’s findings that pressing headache quality in men increased the likelihood of missed diagnoses. This suggests that clinicians should be more vigilant in recognizing non-canonical symptoms in men to improve diagnostic accuracy.
The Role of Treatment Strategies
Beyond diagnosis, the study also explored differences in treatment strategies. Women were more likely to have used triptans and received prophylactic treatment prior to tertiary evaluation. This disparity in treatment approaches may reflect both biological differences and societal biases in how men and women report and manage pain.
“Women were significantly more likely to use one or more triptans as acute medication compared to men,” the study reports, highlighting a potential gap in treatment access or utilization.
Historical Context and Future Directions
The prevalence of migraine is two to three times higher in women than in men, a statistic that has historically contributed to the stigma of migraine as a predominantly female disorder. This perception may deter men from seeking care or accurately reporting symptoms, leading to underdiagnosis.
Historically, the medical community has focused on typical migraine presentations, which align more closely with symptoms reported by women. This focus may inadvertently perpetuate diagnostic disparities. As Dr. Schneider suggests, “Re-evaluating diagnostic guidelines to include a broader spectrum of symptoms could help bridge this gap.”
Looking Ahead: Bridging the Gap
The study underscores the need for increased clinician awareness and education on sex-related differences in migraine presentation. By recognizing non-canonical symptoms and adjusting diagnostic criteria, healthcare providers can improve diagnostic accuracy and treatment outcomes for all patients.
Future research should aim to validate these findings across diverse populations and clinical settings, exploring the biological and cultural factors contributing to these disparities. As the medical community continues to unravel the complexities of migraine, a more inclusive approach could lead to better care and improved quality of life for both men and women affected by this challenging condition.
Ultimately, addressing sex-related disparities in migraine care requires a multifaceted approach, involving changes in clinical practice, increased research funding, and public awareness campaigns to destigmatize migraine and encourage all individuals to seek timely and effective treatment.
