[Migraine in men: biological, psychosocial and clinical characteristics]

Migraine affects 15% of the global population, with men being 2-3 times less frequently affected than women and are markedly underrepresented in research and clinical care. The condition is frequently underdiagnosed in men.

The aim of this work is to describe the biological and psychosocial characteristics of migraine in men in order to improve the understanding of sex-related differences and to enhance the diagnostic precision and treatment for men.

This article is a narrative review based on a structured literature search in PubMed using relevant search terms related to migraine and sex differences.

Biologically, men differ from women through hormonal influences on the calcitonin gene-related peptide (CGRP), pituitary adenylate cyclase-activating polypeptide (PACAP) and transient receptor potential (TRP) signaling pathways, which modulate pain processing. Clinically, men exhibit on average shorter attacks, lower intensity, more frequently dull-pressing pain and fewer vegetative accompanying symptoms. This presentation often leads to misdiagnosis. Additionally, role expectations, stigma and lower help-seeking behavior contribute to symptoms being reported later and underestimated more often. Although modern therapies are similarly effective in both sexes, men receive prophylactic treatment less frequently.

The sex-specific biological and psychosocial differences demonstrate that men present with a distinct clinical phenotype of migraine. Greater awareness with respect to these characteristics could enhance the diagnostic accuracy and support more individualized treatment.