“This is not because of any genetic factors — since genetics play a role for both men and women — but because of hormonal fluctuations in women, particularly estrogen, which causes them to have more migraines than men,” says Medhat Mikhael, MD, a pain management specialist and medical director of the nonoperative program at MemorialCare Spine Health Center at Orange Coast Medical Center in Fountain Valley, California. But there’s more to the story: Men are also less likely to own up to living with migraine. According to an article published in JAMA in 2022, only 6 percent of men reported having migraine symptoms, compared with 17 percent of women. In practical terms, this means men are less likely than women to talk to a doctor about their experiences with the disease, go to the emergency room during attacks, take prescription migraine medications, or use preventive treatments, research has shown. Instead, men may power through a migraine attack and attempt to treat it with over-the-counter medication, says Dr. Mikhael. If this sounds like you, you may be ignoring your symptoms at your own peril. For one thing, there are medications you can take that can prevent attacks — or at least render them less frequent or severe. What’s more, as a man, you may be at risk of more serious health concerns that are linked to migraine.
What Migraine Looks Like in Men
For most men and women, a migraine attack follows the same basic pattern. Thirty to 60 minutes before migraine pain comes an aura, which Cleveland Clinic says can include an array of symptoms: visual disturbances, such as seeing zigzags or flashing lights; tingling, numbness, or weakness; and slurred speech. After that, an intense headache develops, and with it comes sensitivity to light, noise, and smells, as well as nausea and vomiting that can last 4–72 hours. Afterward, many people experience a “migraine hangover” for a day or two and may feel depressed or fatigued. Some symptoms are less likely among men than women, though. “Men with migraine are less likely than women with migraine to have one-sided headaches or throbbing headaches,” says Gina Dumkrieger, PhD, a senior research fellow and assistant professor of neurology at Mayo Clinic in Tempe, Arizona. “They are also less likely to have non-headache symptoms, such as nausea, light sensitivity, sound sensitivity, and allodynia [hypersensitivity to touch].” People who have migraine are also at risk for cardiovascular complications — heart attack, stroke, and atrial fibrillation, according to a study published in The BMJ — that “seem to be more pronounced and more serious in men than women,” says Mikhael. “This is particularly true of men who have neurological symptoms like tingling in the face or an arm, or repeat blurring of their vision and seeing zigzag lines,” he says.
Managing Male Migraine
If you’re a man who experiences migraine attacks only occasionally, and they don’t interfere with your quality of life, you may be fine managing the disease on your own. You can do this by avoiding triggers (physical exertion can be a big trigger for men, according to the National Headache Foundation) and treating symptoms as they occur. But if you’re sidelined by migraine at least four days a month — or have disabling attacks two days a month — you can benefit from preventive treatment, according to the American Headache Society. This likely will mean taking a medication, such as a beta-blocker, calcium channel blocker, anti-seizure medication, or CGRP (calcitonin gene–related peptide) inhibitor, or getting botulinum injections, says Mikhael. Preventive treatments can reduce both the frequency and severity of migraine attacks. “Don’t just treat your frequent migraines with something over the counter, not knowing that one day, migraines might hit you with a major complication,” he says. If you have a family history of migraine, or have recurrent attacks that come with vision disturbances and neurological symptoms, it’s important to seek care, says Mikhael. Don’t try to power through the pain.
