Sex differences in clinical characteristics of migraine and its burden: a population‐based study

Abstract

AbstractBackground and purposeUnderstanding migraine in a sex‐specific manner is crucial for improving clinical care, diagnosis and therapy for both females and males. Here, data on sex differences are provided in the presentation of migraine in a large European‐based population cohort, which is representative of the general population.MethodsA population‐based study of 62,672 Danish blood donors (both present and previous donors), of whom 12,658 had migraine, was performed. All participants completed a 105‐item diagnostic migraine questionnaire sent via an electronic mailing system (e‐Boks) between May 2020 and August 2020. The questionnaire allowed for correct diagnosis of migraine according to the International Classification of Headache Disorders, third edition.ResultsThe migraine questionnaire was in‐cohort validated and had a positive predictive value of 97% for any migraine, a specificity of 93% and a sensitivity of 93%. There were 9184 females (mean age 45.1 years) and 3434 males (mean age 48.0 years). The 3‐month prevalence of migraine without aura was 11% in females and 3.59% in males. The 3‐month prevalence of migraine with aura was 1.72% in females and 1.58% in males. In females, the age‐related 3‐month prevalence of migraine without aura increased markedly during childbearing age. In males, migraine both with and without aura showed less age variation. Females had a higher frequency of migraine attacks (odds ratio [OR] 1.22) but a lower frequency of non‐migraine headaches (OR = 0.35). Females also had a greater intensity of pain, more unilateral and pulsatile pain, and exacerbation by physical activity (OR = 1.40–1.49) as well as more associated symptoms (OR = 1.26–1.98). Females carried 79% of the total migraine disease burden, which was almost exclusively driven by migraine without aura (77%), whilst there was no sex difference in the disease burden of migraine with aura.ConclusionFemales have more severe disease, resulting in a much higher migraine disease burden than indicated by prevalence alone.