IS THERE REALLY A CONNECTION BETWEEN MIGRAINES AND GENDER?

#SYSTEMPHARM #UKRAINE

At the 17th European Headache Congress in Barcelona, experts discussed gender differences and difficulties in obtaining accurate estimates of migraine prevalence. Making a correct diagnosis is a necessary condition for receiving appropriate treatment. Migraine is considered mainly a female disease. Its frequency, duration, and severity tend to be higher in women, and women are also more likely than men to receive a migraine diagnosis. However, gendered expectations, differences, and problems with migraine classification make it difficult to estimate its true prevalence among men and women.

Difference in symptoms

Headache affects 50% of the general population; Tension headaches and migraines are two of the most common types of headaches. According to epidemiological studies, migraine affects women more often, with a ratio of 3:1 women to men. There are numerous studies that explain why this might be, and most of them focus mainly on factors related to women, such as hormones and the menstrual cycle.

The main theses that were highlighted by the researchers:

Despite years of research, there is no single clear factor that explains this significant difference between women and men.

One factor in these perceived gender differences in migraines is that women seem to report their migraines differently than men, and they also have different symptoms. For example, women are more likely than men to report severe pain, and their migraine attacks are more likely to be accompanied by photophobia, phonophobia, and nausea, whereas men’s migraines are more likely to be accompanied by aura.

By favoring female symptoms, the classification system may miss male symptoms because they are not properly classified.

The 3:1 ratio that has been claimed for decades is wrong, but we still don’t have the data. The criteria we have [for migraine classification] are useful for clinical trials, but they are useless for determining the ratio of men to women.

A new definition of migraine is needed Migraine is an episode, not an attack. Attacks start suddenly, and the onset of a migraine is not sudden—it is an episode with a headache attack.

Inadequate diagnosis in menopause

Menopause is associated with an increased prevalence of migraines, but women do not discuss headache symptoms with a gynecologist.

Unpublished results of a survey of 117 women attending the specialist menopause service at St Bartholomew’s Hospital. Among respondents, 34% reported having episodic migraine, and another 8% reported having chronic migraine.

In this population of women who did not report headache as a symptom [to the menopause service until asked during the survey], 42% had a positive diagnosis of migraine. They mostly relied on prescribed paracetamol and codeine or bought them without a prescription, and only 22% of them took triptans. Part of the problem is that they did not spontaneously report headache as a symptom of menopause, so they did not consult their primary care physicians about the headache.

A correct diagnosis by a consultant is a prerequisite for receiving appropriate migraine treatment. However, according to a US study published in 2012, only 45.5% of women with episodic migraines consulted a doctor who prescribed medication. Of those who applied, 89% received the correct diagnosis and only 68% received appropriate treatment.

A larger, more recent study confirmed that there is a huge unmet need to improve the care of this patient population. The Chronic Migraine Epidemiology and Outcomes (CaMEO) study, which analyzed data from almost 90,000 participants, found that only 4.8% of people with chronic migraine received counselling, correct diagnosis and treatment, while 89% of women with chronic migraine were undiagnosed.

In addition, the OVERCOME study found that although many people with migraine had repeated visits, they consulted their doctors about other health problems.

This makes it clear that people in other specialties need to be more knowledgeable about identifying and diagnosing headaches. This is where the real need lies in headache management.

Original article: https://www.medscape.com/viewarticle/migraine-really-female-disorder-2023a1000v35?src=