The latest analysis focused exclusively on men.

“Contrary to popular belief that migraine is a female disease, it also affects men, in whom the symptoms may be more severe. Men seek medical help less often and later, overuse over-the-counter medications and, interestingly, supplements, their attacks last longer, and more often lead to chronic illness. Furthermore, men feel stigmatised and embarrassed,” said the study’s first author, neurologist Marta Waliszewska-Prosół, PhD, from the Department of Neurology at the Medical University of Wrocław.

The project, conducted as an online survey, included more than 3,200 participants, including 599 men aged 13 to 80. It is the largest analysis of migraine in the Polish population to date.

Results were published in The Journal of Headache and Pain.

“In the vast majority of observational and clinical studies, 80–90% of the study group consists of women. Men are usually an irrelevant comparator, not included in comparative analyses, and the studies themselves focus solely on the female perspective. 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,” Waliszewska-Prosół said.

The study found men were less likely than women to report visual and sensory aura symptoms, but more likely to experience prodromal symptoms such as anxiety, fatigue, or irritability. Recovery time after an attack averaged 24 hours for men compared to 10 hours for women.

“This means that attacks in men are longer and often more severe, which was somewhat surprising to us, as this has not been reported before. It is very rare, even in doctors’ offices, to hear men directly complain about headaches and the symptoms accompanying attacks that so significantly impede their daily functioning,” Waliszewska-Prosół said.

Medication use was significantly higher in men. More than 80% used prescribed painkillers (compared to 69% of women), 77% used over-the-counter drugs (52% of women), and 43% used natural or alternative products (15% of women). Only 21% used preventive treatment, compared to 38% of women. Nearly 30% of men met the criteria for painkiller overuse, compared to 22% of women.

“However, they should not be blamed for this. Many of them had not received any treatment beyond another painkiller for years. Our respondents were surprised that there were medications that could be taken regularly to prevent attacks and, above all, that migraine could be treated,” she said.

Men also reported spending twice as much on medication as women, an average of 200 PLN monthly compared to 100 PLN. Chronic migraine was diagnosed more often in men (10% compared to 6.5% in women).

“In men, we observe a faster transition from episodic to chronic migraine, known as chronicity of the disease. Besides the risk factors common to both sexes, this is also due to, among other things, long-term neglect of the disease and lack of proper treatment,” Waliszewska-Prosół said.

Gender differences also appeared in the impact of migraine on daily functioning. Women were more likely to develop depression or withdraw from household and social activities, while men missed work more often and reported lower productivity.

“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 the globe’ cannot affect men. Therefore, men often see a doctor many years later, when they are completely unable to function. And then their treatment is much more challenging, 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,” she said.

She added that some doctors still downplay the disease. “Sometimes they are downplayed, called an ailment, a ‘person’s nature’, rather than a disease. The patient is advised to take a pill and go home. When a man hears something like this, he won’t return, precisely for psychosocial reasons. Women are more determined, so they will keep searching and consult other specialists. This may be the reason for the differences in treatment we observed,” she said.

“In my opinion, migraine is a disease marginalised in both sexes (both by the system and by decision-makers), which should be emphasised and efforts should be made to change it. However, in the case of men, there is even less understanding and acceptance. There is still a lack of awareness that it is a chronic, neurological disease that requires a systemic treatment. Until the entire medical community speaks this way about it, society will not change its approach,” she said.

“Remember that as many as 6 million people in Poland may suffer from migraine,” she added.

Waliszewska-Prosół called for education campaigns targeting men and continued research. “We should also continue studies like ours to determine whether the different course of the disease in both sexes should also influence treatment decisions,” she said.

“I would like our work to stop people from talking about migraine as a female disease. This is false, because migraine affects both sexes. And although women suffer more often, men tend to suffer more severely,” she concluded.

Katarzyna Czechowicz (PAP)

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