Exploring Sex Differences in Migraine

Persistent Sex Disparities in Migraine

Migraine remains one of the leading causes of disability worldwide, with recent global data showing women bearing more than twice the burden in years lived with disability compared to men. A 2025 analysis of headache disorders estimated migraine prevalence at around 14-24% overall, but consistently higher in women (17-20% or more) than men (10% or less), with women experiencing longer attack durations—often 1.15 to 1.62 times longer—and more associated symptoms such as nausea, photophobia, and phonophobia.

This imbalance has drawn renewed attention through a wave of 2025 publications reviewing clinical features across thousands of patients. Women report higher pain intensity and greater frequency of hallmark symptoms, while men tend to describe shorter, less intense attacks with fewer classic features. These differences contribute to diagnostic challenges: in one 2025 tertiary center study of over 1,100 patients, men were far less likely to have received a migraine diagnosis before referral (57% versus 74% for women), increasing the odds of missed recognition when symptoms deviate from the textbook female-presenting profile.

The stakes extend beyond individual suffering. Migraine drives substantial productivity losses, healthcare costs, and reduced quality of life, with women disproportionately affected during peak working and reproductive years. Inaction on sex-specific patterns risks perpetuating under-treatment in men—who may avoid seeking care due to the 'women's disease' stigma—and suboptimal management in women despite their higher burden. Recent work also flags potential differences in response to therapies, including CGRP-targeted drugs, where some acute treatments show stronger effects in women based on post-hoc FDA data reviews.

Non-obvious tensions include the interplay of biology and society: hormonal fluctuations explain much of the female predominance post-puberty, yet cultural biases amplify diagnostic delays in men. Meanwhile, even as research funding for women's health conditions like migraine remains disproportionately low in some systems, the accumulation of 2025 evidence strengthens calls for inclusive studies that account for both sexes to close these gaps.