Migraine afflicts more women than men by a ratio of 3 to 1. However, that still means millions of men have migraine — about nine million in the U.S. alone. I’ve counseled many such men in my decades of work as a psychologist focusing on headache disorders and can attest that in no way is migraine a “women’s disease.” But there are important differences in the way men tend to deal with migraine. The invisible nature of migraine plays right into typically male behavioral weaknesses, thus severely hurting men’s abilities to handle the challenges of living with migraine and reducing their quality of life.
Please note that while my observations are generalizations based on the majority of men, there are certainly male headache patients who don’t fit the male behavioral stereotype. Most men, however, will relate to some part of this discussion, and I speak to them when I say: Men, here are ways your usual coping skills may be working against you when it comes to your headache and migraine.
“Male” behaviors that worsen migraine
Not seeking medical care. Compared to women, men are less willing to deal with medical issues. An estimated 40% of men get no routine care, seeing a doctor only when they have symptoms of illness or an injury. Many men do not regard a headache as enough of a reason to see a doctor, especially when they know other men and women who don’t seek medical care for their headaches.
Toughing it out. An unfortunate byproduct of avoiding the doctor is the tendency to try to tough it out and keep functioning despite head pain by self-treating with large quantities of over-the-counter medications. This can lead to “medication overuse headache,” also known as rebound headache, which can sometimes be even more disabling than the original, and still underlying, migraine.
Needing control. Migraine is unpredictable, and so is its timetable for treatment; it can take a while to find the right combination of medications and/or non-pharmacologic treatments that will work. To find the right treatment takes time and the process cannot be rushed. Relinquishing the illusion of control is difficult for many men; they find it frustrating not to be able to predict which treatment will be effective, or when.
Binary mindset. Migraine is a complex disorder whose treatment is often complex – rarely is it as simple as “take this pill and you’ll feel better.” This doesn’t sit well with many men, who have been socialized to see the world more in terms of black and white, and less in shades of gray.
- Historically, growing up male has meant being steered toward careers with right and wrong answers, like engineering, accounting, law, or the construction trades. Women, with more limited options, were diverted to careers like teaching, nursing and social work, which are also open to more nuance. A teacher can take pride in helping a previously failing student achieve a C, and a social worker can see progress when a couple confines their arguments to words and not fists. But it’s not acceptable for an accountant to have only 10% of his clients charged with tax fraud or for a carpenter to install 10 windows but only seven of them open properly.
- The world is changing and stereotypes are shattering, yet men’s social conditioning continues. The result: It is often hard for men to commit to a migraine treatment plan without guarantees that it will work right away.
Needing proof. It can be difficult for men to recognize and accept an invisible injury or illness. “Real” medical issues must have visual proof of some kind, be it a shadow on an X-ray; a cast or a walker; a pacemaker or joint replacement; plus the heroic narrative that comes with a sports or work injury or a surgery. Migraine falls short of that standard. Your changes in brain chemistry aren’t evident on the outside, and rarely does migraine come with a heroic narrative (although a small number are triggered by concussions). But it doesn’t make migraine any less of a real disease.
What works for men with migraine
For men who seek treatment, the potential rewards are great. In fact, achieving success in migraine management can be easier for men than for women, since men aren’t subject to the hormonal fluctuations that may impair treatment effectiveness throughout a woman’s lifetime. The first step, however, is getting past that mental barrier that holds back so many men: The willingness to acknowledge the reality and seriousness of headache, and to seek help. This enables a patient to start gaining control over health and quality of life.
Since many men are task-oriented, they often do well with behaviorally-oriented psychological interventions:
- Strategies that have proven effective with many male migraine patients in our practice are Cognitive-Behavioral Therapy (CBT), Acceptance & Commitment Therapy (ACT) and Goal-Achieving Psychotherapy (GAP).
- Relaxation, mindfulness and exercise-based strategies such as biofeedback, meditation, yoga and rational exercise programs are effective in controlling headache and decreasing reliance on medication.
- Because stress is a major migraine trigger, intervention in areas of stress reduction and lifestyle management have led many men to not only experience headache relief but also to regain control over the quality of their work and personal lives.
Despite the perceptions of many men, migraine is a real disease. It is a disorder of the brain chemistry and can result in reduced quality of life, days lost from work, and even disability. But treatment can help improve the lives of men with migraine. Too many men suffer needlessly when there is evidence-based help available.