On International Women’s Day 2020, we are taking the opportunity to shine a light on women who live with migraine and their specific needs. Migraine affects men and women differently. This is a little-known fact with considerable individual and socioeconomic implications that are currently dismissed in health policy. Today, we explore the migraine care gaps that stand in the way of gender equality for women. While we acknowledge that gender is not binary and can encompass several fluid categories, in this article we will focus on men and women, due to the lack of data on other gender groups.
Migraine is a complex neurological disease that affects the structure and functioning of the brain. Approximately one in seven people worldwide suffer from migraine,[i] and it is three times as common in women as in men.[ii] The migraine experience is also quite different between genders, with women reporting more frequent attacks that last longer, with a higher degree of disability than men.[iii] Women have an overall tougher migraine journey: disease onset often coincides with menstruation at puberty,[iv] they are at higher risk to progress from episodic to chronic migraine in adulthood,[v] and peri-menopause can worsen symptoms in up to 45 percent of sufferers.[vi]
Medical differences in the way migraine affects men and women are only the beginning. Gender cultural attitudes and socioeconomic norms can further contribute to a different experience of migraine between men and women. Cultural stereotypes lead women with migraine to worry about not being taken seriously, while the same stereotypes prevent men from seeking medical advice as they think migraine is a ‘women’s disease’.[vii]
The migraine ordeal, perpetrated by a generalized lack of disease awareness, continues in the workplace, where discrimination is common, and support is rare.[viii] Migraine causes a sizeable loss of productivity in both men and women, with women losing more work days to sickness than men. Overall, women report that migraine has a higher negative impact on their education, career and earnings, compared to men.[ix],[x] They also report feeling less understood and less supported by their employers and colleagues in the workplace. Even family life is affected, with some migraine sufferers choosing to have fewer children than they would like, or avoiding having children altogether, because of their disease.[xi]
Can women really achieve gender equality when so many are unable to reach their potential because they are being held back by a misunderstood, underdiagnosed and undertreated neurological disease?[xii]
Today, for International Women’s Day, we call for health policies to address the migraine care gaps that specifically affect women and their efforts to achieve gender equality. Supporting brain research in women and improving education of these gender differences is crucial to help ease the burden of migraine on individuals and societies.
What will you do today to help speak up to address the migraine care gaps that stand in the way of gender equality?
What will you do to #RespectMigraine?
This article was co-authored by Maria Teresa Ferretti of the Women’s Brain Project and Gisela Terwindt of the Leiden University Medical Center.
[i] Steiner TJ, et al. Migraine: the seventh disabler. J Headache Pain. 2013; 14(1): 1.
[ii] Diamond S, et al. Patterns of diagnosis and acute and preventive treatment for migraine in the United States: results from the American Prevalence and Prevention study. Headache. 2007; 47: 355-363.
[iii] Vetvik KG, MacGregor EA. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol. 2017; 16:76-87.
[iv] Casucci G, Terlizzi R, et al. Headache in school age. Neurol Sci. 2014; 35 (Suppl 1): S31-S35.
[v] May A, Schulte LH. Chronic migraine: risk factors, mechanisms and treatment. Nat Rev Neurol. 2016; 12(8): 455-64.
[vi] The Migraine Trust. Menopause and midlife. Available at: https://www.migrainetrust.org/about-migraine/trigger-factors/menopause-and-midlife/. Accessed March 2020.
[vii] Parikh SK, Young WB. Migraine: Stigma in Society. Curr Pain Headache Rep. 2019; 23(1):8.
[viii] The All-Party Parliamentary Group on Primary Headache Disorders (APPGPHD). Headache Disorders – not respected, not resourced. 2010. Available at: https://www.migrainetrust.org/wp-content/uploads/2015/12/2010Mar-APPGPHD_REPORT_Headache_Disorders-NotRespNotReso.pdf. Accessed March 2020.
[ix] Dueland AN, Leira R, et al. The impact of migraine on work, family, and leisure among young women -- a multinational study. Curr Med Res Opin. 2004; 20(10): 1595-604.
[x] Steiner TJ, Stovner LJ, et al. The impact of headache in Europe: principal results of the Eurolight project. J Headache Pain. 2014; 15:31.
[xi] Lampl C, Thomas H, et al. Interictal burden attributable to episodic headache: findings from the Eurolight project. J Headache Pain. 2016; 17:9.
[xii] Miller S, Matharu MS, et al. Migraine is underdiagnosed and undertreated. Practitioner. 2014; 258(1774): 19-24, 2-3.