Migraine in Men: Underdiagnosis, Unique Patterns, and Barriers to Care

Migraine is often described as a condition that primarily affects women, and statistically this is accurate. Women experience migraine approximately three times more often than men. But the framing of migraine as a predominantly female condition has had an unintended consequence: men with migraine are systematically underdiagnosed, undertreated, and underrepresented in both clinical care and migraine research.

Approximately one in twelve men in the United States meets diagnostic criteria for migraine. This represents millions of individuals, many of whom have never received an accurate diagnosis and are managing a serious neurological condition with over-the-counter medications, self-imposed restrictions on activity, and the accumulated social burden of a condition that is not recognized as the cause of their symptoms.

How Migraine Presents Differently in Men

Migraine in men is not simply a less frequent version of migraine in women. There are genuine differences in how the condition presents that affect diagnosis and management.

Men are less likely to report the full constellation of migraine-associated symptoms, including nausea, light sensitivity, and sound sensitivity, either because these symptoms are less prominent in male migraine presentations or because social norms around health communication discourage detailed symptom reporting. Men more commonly describe migraine pain as pressure or tightness rather than pulsating or throbbing, which can lead to misdiagnosis as tension-type headache.

The triggers that are most commonly implicated in male migraine differ from those in female migraine. Hormonal triggers, which drive a substantial portion of migraine burden in women, are not relevant in men. Sleep disruption, physical exertion, and alcohol, particularly beer and whiskey, are among the triggers most commonly reported by men with migraine. These differences are clinically meaningful because they affect trigger management strategies.

Why Men Are Underdiagnosed

Several factors contribute to underdiagnosis of migraine in men. The cultural association of migraine with women means that both patients and physicians may not consider migraine as a diagnosis when a man presents with severe headache. Men are less likely to seek medical care for headache than women, and when they do, they may minimize symptoms in ways that make the clinical picture less clear.

Research has documented that physicians are less likely to apply migraine diagnostic criteria systematically when evaluating male patients with headache compared to female patients, reflecting implicit bias in diagnostic reasoning. Men who are diagnosed with migraine may also receive less aggressive treatment than women, a finding that suggests underestimation of migraine burden in male patients extends beyond diagnosis to management.

Unique Challenges for Men With Migraine

Men with migraine face workplace and social challenges that are somewhat distinct from those faced by women. The expectation of stoicism in response to pain that is prevalent in many workplace cultures creates pressure to minimize or conceal migraine symptoms. Men may be less likely to request workplace accommodations for migraine, both because of cultural pressure and because they are less likely to be aware that such accommodations are available.

Physical exertion as a trigger creates specific challenges for men who are athletes, who engage in manual labor, or who have fitness goals that are important to their identity and wellbeing. Understanding the relationship between exercise intensity, hydration, and migraine risk allows men to manage this trigger more effectively without necessarily abandoning physical activity.

Treatment Considerations

The principles of migraine treatment are the same for men and women, but some practical considerations differ. Men with migraine who are not yet diagnosed need to be encouraged to seek evaluation rather than continuing to manage attacks with over-the-counter medications. The threshold for preventive treatment in men may be the same as in women, but men are less likely to be offered preventive treatment even when they meet the frequency criteria.

Testosterone and other male sex hormones have complex and incompletely understood relationships with migraine. Some evidence suggests that testosterone may have a protective effect against migraine, which could partially explain the lower prevalence in men. Changes in testosterone levels, as occur with androgen deprivation therapy for prostate cancer, have been associated with new onset or worsened migraine in some patients.

Encouraging Men to Seek Care

The most important step for many men with migraine is simply seeking evaluation. A physician visit that results in an accurate diagnosis opens the door to treatments that are substantially more effective than the over-the-counter approaches most undiagnosed men rely on. Bringing a headache diary that documents attack frequency, duration, severity, and associated symptoms to the appointment provides objective data that supports accurate diagnosis and appropriate treatment selection.