Fitzek Mira P, Boucherie Deirdre M, de Vries Tessa, Handtmann Cleo, Fathi Haniyeh, Raffaelli Bianca, MaassenVanDenBrink Antoinette
Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.
Junior Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany.
J Headache Pain. 2025 Jan 3;26(1):3. doi: 10.1186/s10194-024-01936-7.
Migraine is a common primary headache disorder, less frequently affecting men than women, and often regarded as predominantly a "women's disease." Despite this, migraine in men presents with unique characteristics in terms of symptoms, treatment responses, comorbidities, and pain perception. Historically, research has focused more on migraine in women, overlooking critical male-specific aspects.
This review delves into the epidemiology, clinical presentation, and particular challenges of diagnosing and managing migraine in men. It addresses sex-specific triggers, hormonal influences, and comorbid conditions affecting migraine prevalence and severity in men. Additionally, the review evaluates current therapeutic strategies, underscoring the necessity for individualized approaches. Men with migraine often exhibit atypical symptoms compared to the ICHD-3 criteria and are less likely to report common associated symptoms. They also tend to have fewer psychological comorbidities, respond more favorably to pharmacological treatments, yet are less likely to seek medical support. The reasons for these sex disparities are complex, involving biological, psychosocial, and cultural factors, such as brain structural differences, differences in functional responses to painful stimuli, hormonal effects, and behavioral influences like adherence to masculine norms and stigma.
Men are underrepresented in clinical migraine research. In contrast, preclinical studies often focus solely in male animals as a result of various misconceptions. This disparity necessitates greater focus on sex-specific aspects of migraine to enhance diagnosis, treatment, and research. Addressing stigma, increasing healthcare access, and ensuring balanced sex and gender representation in future studies is crucial for a comprehensive understanding and effective management of migraine for all patients.
偏头痛是一种常见的原发性头痛疾病,男性患病的频率低于女性,常被视为主要是一种“女性疾病”。尽管如此,男性偏头痛在症状、治疗反应、合并症和疼痛感知方面具有独特的特征。从历史上看,研究更多地集中在女性偏头痛上,而忽视了男性特有的关键方面。
本综述深入探讨了男性偏头痛的流行病学、临床表现以及诊断和管理方面的特殊挑战。它讨论了性别特异性触发因素、激素影响以及影响男性偏头痛患病率和严重程度的合并症。此外,该综述评估了当前的治疗策略,强调了个性化方法的必要性。与国际头痛疾病分类第三版(ICHD - 3)标准相比,男性偏头痛患者通常表现出非典型症状,并且不太可能报告常见的相关症状。他们心理合并症也往往较少,对药物治疗的反应更好,但寻求医疗支持的可能性较小。这些性别差异的原因很复杂,涉及生物、心理社会和文化因素,如脑结构差异、对疼痛刺激的功能反应差异、激素影响以及诸如遵守男性规范和耻辱感等行为影响。
在临床偏头痛研究中,男性的代表性不足。相比之下,由于各种误解,临床前研究往往仅关注雄性动物。这种差异需要更加关注偏头痛的性别特异性方面,以加强诊断、治疗和研究。消除耻辱感、增加医疗保健可及性以及确保未来研究中有平衡的性别代表性,对于全面了解和有效管理所有患者的偏头痛至关重要。