Migraine is rightfully considered a women’s health issue since of the more than 39 million Americans with migraines, 28 million are women. But 11 million is still a lot of men. Unfortunately, men do not seek help as often as women do and we see this in our office and in clinical trials of new drugs for migraines, where the ratio is closer to 1 to 10.
The article notes that men are notoriously bad patients. In our office, it is usually a mother, a wife, or a girlfriend who brings the man to the office. Men consider complaining of a headache or any other symptom a sign of weakness. They just grin and bear until they are totally incapacitated. This is probably one of the reasons why women live longer.
Fortunately, migraines are not life-threatening but they can certainly ruin relationships, affect job performance, cause depression and other problems. Men are often reluctant to share their feelings and see a therapist and have higher suicide rates than women.
Men tend to be not very compliant with treatment and are more likely to come in for Botox injections every 3 months rather than take a pill every day. In this case they are acting rationally since any oral medication has more potential side effects than Botox. Regular exercise, which is at the top of my list of preventive therapies, also tends to appeal to men, but my second recommendation, meditation much less so.
Men are more receptive to the idea of taking a shot for their problem and here they are also correct – taking an injection of sumatriptan (Imitrex) stops an attack of migraine within 10-20 minutes, while a pill of sumatriptan can take up to two hours and may not work as well.
The new class of CGRP monoclonal antibodies (Aimovig, Ajovy, Emgality) also obviates the need for taking a pill every day – they are injected once a month (Ajovy can be injected every three months) to prevent migraines.
The bottom line – if you know a man who admits to having headaches, chances are they are suffering more than they let on. Tell them to see a headache specialist.
