Neurology Today Conference Reporter: American Headache Society Annual Meeting

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Saturday, June 11, 2016

Men with Migraine Are Less Likely Than Women to Be Diagnosed and Treated

BY DAN HURLEY

SAN DIEGO—Although often considered a women's disease, migraine affects a substantial portion of men, yet is diagnosed and treated less often in men than in women, according to results from a large online survey presented here on Friday at the annual meeting of the American Headache Society.

One in four participants (4,294 out of 16,789) in the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study were men who were recruited from an online panel and included if they met the modified International Classification of Headache Disorders criteria for migraine. They were categorized as having either episodic migraine, with fewer than 15 headache days per month, or chronic migraine.

The study found that men were less likely than women to report currently seeing a doctor to manage their headaches (28.6 percent vs 31.1 percent, p< 0.01) and, if physicians were consulted, the men were less likely to receive a migraine diagnosis (59.2 percent versus 77.7 percent, p< 0.001). Men were also less likely to report use of prescription medication for headache (24.1 percent versus 28.2 percent, p< 0.001), or to report use of acute prescription medications (16.5 percent versus 22 percent, p< 0.001). Even so, use of prescription preventives was similar between sexes (12.9 percent vs 12 percent, p=0.11).

"The perception that migraine is a women's disease may contribute to migraine stigma and deny men access to diagnosis and treatment," concluded the study, presented by its first author, Ann Scher, PhD, professor and director of preventive medicine and biostatistics at the Uniformed Services University of the Health Sciences in Bethesda, MD.

A coauthor of the paper, Richard B. Lipton, MD, FAAN, professor and vice chair of neurology at the Albert Einstein College of Medicine and director of the Montefiore Headache Center in the Bronx, NY, said that while migraine is three times more common in women than in men, it's still more prevalent in men than any other neurological disorder.

"Men are less likely to go to the doctor and less likely to be diagnosed with migraine when they do," Dr. Lipton said. "So the perception that migraine is a women's disease may be a barrier to getting diagnosed and treated."

For neurologists, he said, "the key point is that if you see a man with headache, it can be migraine, and it's good to have a high index of suspicion."

Dr. Lipton said physicians might be ignoring diagnostic criteria by incorrectly assuming that all migraines must be accompanied by nausea or photophobia.

"A lot of doctors think that aura is a necessary feature of migraine, but only 20 to 30 percent of patients at most have an aura," Dr. Lipton said. "If you require aura for diagnosis, you miss up to 80 percent of cases."       

The study also found that men with migraine were slightly older than the women at study enrollment (42 years versus 40.8 years; p< 0.001). Men reported fewer headache days per month (4.3 days/month versus 5.3 days/month; p< 0.001).

Both sexes were equally likely to be currently employed. Migraine Disability Scores (MIDAS) were generally lower in men than women (p< 0.001). For example, 15.7 percent of men and 24.1 percent of women were in the highest MIDAS disability category (grade IV).

Significantly fewer men reported allodynia (32.6 percent versus 49.7 percent, p< 0.001) and chronic migraine was a lower proportion of all migraine for men than women (6.5 percent versus 9.6 percent, p< 0.001).

Elizabeth W. Loder, MD, MPH, chief of the division of headache and pain at Brigham and Women's/Faulkner Hospital and associate professor of neurology at Harvard Medical School in Boston, said the study shows that physicians' stereotypes have consequences in the way patients are diagnosed and treated.

"Migraine in men is often overlooked," said Dr. Loder, who was not involved with the study. "It's more prevalent in women but still affects a very substantial population of men."

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