Can Men Get Migraines? Symptoms, Triggers, and Treatment

Men absolutely get migraines, and the condition affects roughly one in eleven of them over a lifetime. The widespread perception of migraine as a “women’s disease” has real consequences: men with migraine are diagnosed later, studied less, and often dismiss their own symptoms as ordinary headaches. While women do experience migraine at about two to three times the rate men do, that still leaves millions of men dealing with a neurological condition that can be disabling, and the way it shows up in men often looks different enough to slip past both the person experiencing it and their doctor.

How Common Migraine Actually Is in Men

A large U.S. life-span study found migraine prevalence of about 8.6% in males compared to 17.5% in females, with an overall rate of roughly 13%. The study also revealed that migraine prevalence in men follows a bimodal pattern, peaking once in the late teens and twenties and again around age 50.¹ That second peak around midlife is worth noting because it coincides with the age when testosterone levels begin declining more steeply, a hormonal shift that may play a role in migraine susceptibility.

Before puberty, the sex gap barely exists. Boys and girls get migraines at similar rates, and in some studies boys actually have slightly higher prevalence. The divergence kicks in after age ten, when female prevalence begins climbing sharply and continues to outpace male prevalence into adulthood.¹ The fact that the gap opens up around puberty is one of the strongest pieces of circumstantial evidence that sex hormones are a major driver of the difference.

Why Men Are Underdiagnosed

If roughly 9% of men experience migraine, you would expect the condition to be caught and treated reliably. It is not. Data from a large tertiary headache center found that only 57% of men arriving for specialist evaluation had previously received a migraine diagnosis, compared to about 74% of women.² That is a striking gap. Nearly half the men walking into a headache clinic had been living with unrecognized migraine.

Several factors converge to produce this underdiagnosis. Men are less likely to seek medical care for headaches in the first place, partly due to cultural expectations around toughing it out and partly because they may genuinely believe migraine is something only women get. Clinicians, in turn, may be primed to consider tension-type headache or cluster headache before migraine when evaluating a male patient. The same tertiary center study found that a pressing quality to the headache substantially increased the chances of a missed diagnosis in men, likely because pressing pain gets mentally filed as “tension headache” rather than migraine.²

There is also a diagnostic criteria problem. The standard clinical criteria for migraine were developed on populations dominated by women. When men present with fewer of the “classic” accompanying symptoms, they can fail to tick enough boxes on a checklist that was never built to capture how migraine looks in them.

How Male Migraine Symptoms Differ

Migraine in men is migraine. The underlying neurology is the same. But the attack profile can differ in ways that matter for recognition and treatment. A longitudinal e-diary study tracking individual attacks found that women’s migraines were more often accompanied by light sensitivity, sound sensitivity, and nausea, while men were somewhat more likely to experience aura, the visual or sensory disturbances that can precede the headache phase.³ A Polish national survey confirmed that men tend to report fewer types of headache overall and are less likely to report the visual and sensory symptoms that accompany the worst attacks.⁴

One finding from that Polish survey is surprising: men reported a longer recovery time after their worst attacks. The median time to return to normal functioning was about 24 hours for men compared to 10 hours for women.⁴ Men were also more likely to experience premonitory symptoms, the subtle early-warning signs like mood changes, fatigue, or food cravings that can appear hours or even a day before the headache arrives. If you are a man who notices a strange fatigue or irritability that reliably precedes a bad headache, that pattern is itself a clue toward migraine.

Researchers have described male migraine presentations as often “atypical” relative to the standard diagnostic checklist, which helps explain the diagnostic gap discussed above.⁵ The word “atypical” is doing a lot of work here. It does not mean that male migraine is unusual in any inherent sense. It means the diagnostic framework was calibrated around a female-majority experience, and male presentations fall outside that frame more often.

The Hormonal Puzzle

The reason women get more migraines than men traces largely to estrogen. Fluctuations in estrogen levels, particularly the sharp drops that occur just before menstruation, are potent migraine triggers. At the cellular level, estrogen appears to lower the threshold for cortical spreading depression, the slow wave of electrical activity across the brain’s surface that underlies migraine aura and likely contributes to the headache itself. Animal research has consistently shown that female brains have a lower threshold for this phenomenon: one study using potassium-selective microelectrodes found the threshold in female rat cortex was roughly 80% lower than in male cortex.⁶ Studies in both mice and rats have replicated this sex difference, with intact females showing significantly more cortical spreading depression events than males.⁷⁸

Testosterone, meanwhile, appears to work in the opposite direction. Research suggests it acts as a neuroprotective agent that may reduce migraine severity and frequency. One line of evidence comes from studies of men with chronic migraine that found low testosterone levels were common in this group, and the relationship appeared to be causal rather than a consequence of the migraines themselves.⁹ A broader review of androgen research found that testosterone shows pain-reducing effects across various animal and human pain studies, though the researchers cautioned that the overall effect on migraine specifically may be modest and the available studies have limitations.¹⁰

There is also genetic evidence pointing to the X chromosome. Linkage analysis in families with typical migraine identified a susceptibility locus on the X chromosome, specifically the Xq24-28 region.¹¹ Since women carry two X chromosomes and men carry one, this could contribute to the overall sex difference in prevalence. But it also means men can inherit migraine susceptibility genes through their mother’s X chromosome, which is one reason strong maternal migraine history can be a meaningful signal for sons as well as daughters.

Common Triggers in Men

Many migraine triggers are shared across sexes: stress, poor sleep, skipping meals, weather changes. But the relative importance of certain triggers can differ for men. Men do not experience the menstrual-cycle-related triggers that are among the most powerful and reliable triggers for women, so their trigger profile tends to be dominated by lifestyle and environmental factors.

Alcohol is one of the most commonly reported dietary triggers, with red wine frequently singled out. A review of the alcohol-migraine relationship noted that components of alcoholic drinks can activate pain pathways and provoke attacks, though the evidence from prospective studies is not always as clean as self-reports suggest.¹² A study of trigger factors in migraine patients found that fasting was the single most common dietary trigger, followed by alcohol, chocolate, and coffee.¹³ Sleep disruption, whether too much or too little, was also a significant factor.

Physical exertion deserves special attention for men because exercise-triggered migraine is at least as common in men as in women. One study found that about half of male migraineurs reported exercise as a trigger, compared to about a third of women, though the difference was not statistically significant.¹⁴ Neck muscle endurance training specifically was shown to trigger migraine-like headaches in a large fraction of migraine patients, with attacks arriving on average about 16 hours after the exercise session.¹⁵ This delayed onset is worth knowing about, because if your worst headaches tend to arrive the morning after an intense workout rather than during it, that is more likely migraine than exertional headache.

Stress is a universal trigger, but the relationship can be counterintuitive. Japanese population research found that self-estimated stress, poor sleep, and having other health conditions were independently linked to headache in both men and women.¹⁶ Many migraineurs report that attacks come not during peak stress but during the “let-down” phase afterward, the weekend after a brutal work week, the first day of vacation. This can be confusing for men who associate their headaches with relaxation rather than strain.

How Treatment Works for Men

The good news is that migraine treatments work in men. The medications are the same regardless of sex, and the evidence base, while skewed toward female participants, supports efficacy in both groups.

Triptans, the workhorse class of acute migraine medications, show similar pain-relief rates in men and women. A pooled analysis of three crossover trials comparing frovatriptan to other triptans found that pain-free rates at two hours were in the low-to-mid 30% range for both sexes, and pain relief rates were in the mid-50% range for both.¹⁷ The relapse rates were also comparable between men and women.

The newer CGRP-targeting therapies, which include injectable antibodies and oral medications, have also been evaluated by sex. A review of outcomes from these treatments found that for episodic migraine prevention, the treatment effect almost always favored the drug over placebo in both women and men. For chronic migraine, the antibody therapies showed similar benefits across sexes.¹⁸ This is reassuring given that CGRP-targeting drugs represent the first migraine-specific preventive class developed in decades.

One area where a sex difference in treatment response has appeared is neuromodulation. A study of U.S. veterans using a remote electrical neuromodulation device found that the study population was nearly evenly split between male and female veterans, and while the device was effective overall, post hoc analysis showed greater effectiveness in female users compared to males.¹⁹ That does not mean the device is useless for men, but it suggests that certain non-pharmacological approaches may need sex-specific expectations about how well they work.

The Productivity Impact Men Don’t Talk About

One of the least-discussed consequences of male migraine is its effect on work capacity. Research on headache-related lost productivity found that for each additional headache day per month, men lost roughly 0.75 to 0.85 days of productive paid work per three-month period. Women, by comparison, lost about 0.34 to 0.53 days per additional headache day.²⁰ In other words, each migraine day appeared to cost men more productivity at work than it cost women, even though women experience more total migraine days. For household work, the productivity losses were more similar between sexes.

Why would an individual migraine day hit men’s work output harder? The researchers focused on attack frequency as the main driver, but it is plausible that men are less likely to have developed coping strategies, less likely to have discussed accommodations with employers, and less likely to have been prescribed preventive medications, all downstream effects of the underdiagnosis problem. A man who does not know he has migraine has no framework for managing it, so each attack lands harder on his schedule.

Migraine Versus Cluster Headache in Men

Part of what muddies the waters for men is that cluster headache, a different primary headache disorder, is more common in men than women. Cluster headache and migraine share some features: both can be triggered by alcohol, and both respond to triptans.²¹ But they differ in important ways. Cluster attacks tend to be shorter (15 minutes to three hours) but more frequent during an active bout, often striking multiple times a day. They are almost always one-sided and accompanied by autonomic symptoms on that side like tearing, nasal congestion, or eyelid drooping. Migraine attacks are longer (four to 72 hours untreated), often but not always one-sided, and accompanied by nausea, light sensitivity, and sound sensitivity.

Because cluster headache carries a reputation as a “male headache,” clinicians may default to considering it first when a man presents with severe headaches. This can delay a migraine diagnosis, especially when the man’s migraines are strictly unilateral or have some autonomic features. If your headaches last more than a few hours and are accompanied by nausea or light sensitivity rather than the sharp autonomic signs of cluster headache, migraine is the more likely diagnosis regardless of your sex.

The Research Gap That Affects Men Specifically

The underrepresentation of men in migraine research is not a minor footnote. A systematic review of clinical trials for biologic migraine agents found that women made up about 85% of total participants, and only two out of all the trials analyzed reported their primary or secondary outcomes broken down by sex.²² A separate analysis of migraine treatment trials in the U.S. similarly found that men were statistically underrepresented.²³

This creates a practical problem. When 85% of trial participants are women and nearly no trials analyze outcomes by sex, we have limited direct evidence about how men respond to specific treatments. The evidence we do have, as described above, is generally reassuring: where sex-specific analyses have been done, treatments appear to work for both groups. But “appears to work” based on sparse subgroup data is not the same as “has been rigorously established.” The systematic review noted that no trial accounted for factors like hormone replacement therapy, hormonal contraceptives, or the menstrual cycle when analyzing drug response, which means the female-dominated results may also be muddied by uncontrolled hormonal variables that do not apply to men at all.²²

Sleep Apnea and Migraine

One comorbidity worth knowing about, especially for men, is obstructive sleep apnea. A large U.S. cohort study found that people with sleep apnea had roughly 1.85 times the risk of developing migraine compared to those without it, and this association held across subgroups including both sexes.²⁴ Since sleep apnea is substantially more common in men, it represents a potential migraine risk factor that disproportionately affects the male population. Not every study has found this link in the general population. An earlier study using a different methodology found no significant relationship between migraine and obstructive sleep apnea.²⁵ The discrepancy may relate to differences in study size, how sleep apnea was measured, or population characteristics, but it means the connection is plausible rather than settled.

For a man with both frequent headaches and symptoms of sleep apnea, such as loud snoring, daytime sleepiness, or waking up gasping, treating the apnea could potentially improve the headache picture as well. At minimum, the overlap is worth raising with a doctor, since sleep disruption of any kind is one of the most reliable migraine triggers.

1
PubMed. Migraine prevalence by age and sex in the United States: a life-span study
2
PubMed Central. Sex-related disparities in migraine recognition and management: insights from a tertiary headache center cohort
3
PubMed. Sex differences in migraine attack characteristics: A longitudinal E-diary study
4
PubMed Central. Migraine in men – differences in phenotype and treatment patterns: results from the Migraine in Poland cross-sectional national survey
5
PubMed Central. Migraine in men
6
PubMed. Potassium-selective microelectrode revealed difference in threshold potassium concentration for cortical spreading depression in female and male rat brain
7
PubMed. Reduced threshold for cortical spreading depression in female mice
8
PubMed Central. Estrogen modulation of cortical spreading depression
9
PubMed Central. Testosterone levels in men with chronic migraine
10
Neurobiology of Pain. The role of androgens in migraine pathophysiology
11
PubMed. Familial typical migraine: significant linkage and localization of a gene to Xq24-28
12
PubMed Central. Migraine and Alcohol-Is It Really That Harmful?
13
Arquivos de Neuro-Psiquiatria. Trigger factors in migraine patients
14
PubMed Central. Migraineurs with exercise-triggered attacks have a distinct migraine
15
PubMed. Muscle endurance training of the neck triggers migraine attacks
16
PubMed Central. Associations between headache and stress, alcohol drinking, exercise, sleep, and comorbid health conditions in a Japanese population
17
PubMed Central. Gender and triptan efficacy: a pooled analysis of three double-blind, randomized, crossover, multicenter, Italian studies comparing frovatriptan vs. other triptans
18
PubMed. Evaluation of outcomes of calcitonin gene-related peptide (CGRP)-targeting therapies for acute and preventive migraine treatment based on patient sex
19
PubMed. U.S. Veterans Using Remote Electrical Neuromodulation for Migraine: A Prospective Real-World Evidence Study of Treatment Patterns, Medication Use, Effectiveness, and Safety (2020-2025)
20
PubMed Central. The relationship between headache-attributed disability and lost productivity: Attack frequency is the dominating variable
21
PubMed Central. Debate: Are cluster headache and migraine distinct headache disorders?
22
PubMed Central. Gender bias in clinical trials of biological agents for migraine: A systematic review
23
PubMed. Minority Representation in Migraine Treatment Trials
24
PubMed. Association between obstructive sleep apnea and migraine: A United States population-based cohort study
25
PubMed Central. Migraine and sleep apnea in the general population