Sex Differences in Chronic Migraine: Focusing on Clinical Features, Pathophysiology, and Treatments

Chia Kuang Tsai, Chia Lin Tsai, Guan Yu Lin, Fu Chi Yang*, Shuu Jiun Wang

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Purpose of Review: This review provides an update on sex differences in chronic migraine (CM), with a focus on clinical characteristics, pathophysiology, and treatments. Recent Findings: Approximately 6.8–7.8% of all migraineurs have CM, with an estimated prevalence of 1.4–2.2% in the general population. The economic burden caused by CM, including medical costs and lost working ability, is threefold higher than that caused by episodic migraine (EM). Notably, the prevalence of migraine is affected by age and sex. Female migraineurs with CM experience higher levels of headache-related disability, including longer headache duration, higher frequency of attacks, and more severely impacted efficiency at work. Sex hormones, including estrogen, testosterone, and progesterone, contribute to the sexually dimorphic characteristics and prevalence of migraine in men and women. Recent neuroimaging studies have indicated that migraine may have a greater impact and cause greater dysfunction in the organization of resting-state functional networks in women. Accumulating evidence suggests that topiramate, Onabotulinumtoxin A and calcitonin gene-related peptide (CGRP) monoclonal antibodies are effective as the preventative treatments for CM. Summary: Recent evidence highlights a divergence in the characteristics of CM between male and female populations. The data comparing the treatment response for CM regarding sex are lacking.

Original languageEnglish
JournalCurrent Pain and Headache Reports
DOIs
StateAccepted/In press - 2022

Keywords

  • Chronic migraine
  • Gender
  • Management
  • Pathophysiology
  • Sex difference

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