Women with Little to No Migraine Disability Had a Lower Quality of Life Than Men

Credit: Adobe Stock/ LIGHTFIELD STUDIOS

A new study found health-related quality of life, both physical and mental, only worsened with migraine, and the association had gender-specific patterns.¹

“These findings point to the importance of identifying treatment and management strategies that can improve HRQoL among those with the most severe migraine-related disability, and the importance of not overlooking mild migraine-related disability, especially in men,” wrote investigators, led by Alexander C.T. Tam, from Centre for Advancing Health Outcomes, Providence Research in Vancouver.

Migraines have a greater prevalence in women and men. Not only that, but research indicates migraine attacks may also be more severe in women. People with migraine, along with comorbid chronic conditions such as rheumatoid arthritis, neurological disorders, depression, anxiety, and stroke, have any impacted quality of life.^2,3

Although females may get migraines worse, whether health-related quality of life (HRQoL) differs between genders is unknown.¹ Investigators aimed to quantify the HRQoL by different levels of migraine disability and by gender.

Investigators conducted this cross-sectional study within a broader, Canada-wide study evaluating the productivity loss of people with various diseases, such as migraine, atopic dermatitis, and alopecia areata. The team administered an online survey to employed adults who self-reported a migraine diagnosis.

Based on their Migraine Disability Assessment Questionnaire (MIDAS) scores, participants were characterized as having either little to no, mild, moderate, or severe migraine-related disability. The physical and mental components of HRQoL and health utilities were measured through the Veterans Rand 12 Item Health Survey.

The sample (n = 441) was mostly women (60.1%), White (75.5%), and had a mean age of 37 years. Participants had a mean health utility, physical component summary score, and mental component score of 0.61, 45.0, and 43.4, respectively. These 3 scores decreased with increased migraine disability levels.

For the most part, gender differences in HRQoL within each migraine disability level were not statistically significant. The exception was participants who were in the disability level of little to none. Among this low disability level, women had lower mean mental component scores (44.0 vs 55.1; P < .001) and health utility (0.66 vs 0.81; P < .001) compared with men.

“This implies that even less severe migraine-related disability levels may negatively affect HRQoL among women,” investigators wrote.

The team explained how this gender difference in health utility could be explained by assessing treatments. Men are more likely to take no medication or over-the-counter medications, whereas women are more likely to take prescription medicine. Men are also less likely to contact a headache center or seek consultations for their treatment, resulting in poorer migraine management than women.

A linear regression analysis showed women with severe migraine-related disability had a decreased health utility compared to women with little to no disability (adjusted difference, -0.16; 95% confidence interval [CI], -0.24 to -0.09). The analysis also showed reduced health utility increased with migraine disability level (adjusted differences, mild (-0.16; 95% CI, -0.24 to – 0.09), moderate (0.18; 95% CI, -0.26 to -0.10), and severe (-0.28; 95% CI, -0.37 to -0.20).

Investigators wrote the study was limited by participants self-reporting their migraine diagnosis in the survey, not differentiating the type of migraine respondents, and not obtaining information on specific medications or frequency of medication use. The sample also only included employed adults and used survey quotas based on age, sex, and migraine disability to balance across groups—all of which may have led the sample to not be representative of Canadians living with migraine.

“Given the patterning we found, models should include gender- and disability level-specific estimates of HRQoL,” investigators wrote. “Furthermore, clinicians treating those with migraine should also not overlook milder disabilities, as HRQoL burden may still be high. Overall, this study underscores the importance of taking a gendered approach to migraine research and treatment as the associations between disability and HRQoL are nuanced.”

References

1. ^{Tam ACT, Naik H, Trenaman L, Lynd L, Zhang W. Health-related quality of life among women and men living with migraine: a Canada-wide cross-sectional study. J Headache Pain. 2024;25(1):170. Published 2024 Oct 9. doi:10.1186/s10194-024-01882-4}
2. ^{Graves EB, Gerber BR, Berrigan PS, et al. Epidemiology and treatment utilization for Canadian patients with migraine: a literature review. J Int Med Res. 2022;50(9):3000605221126380. doi:10.1177/03000605221126380}
3. ^{Amiri P, Kazeminasab S, Nejadghaderi SA, et al. Migraine: A Review on Its History, Global Epidemiology, Risk Factors, and Comorbidities. Front Neurol. 2022;12:800605. Published 2022 Feb 23. doi:10.3389/fneur.2021.800605}