Sex matters -- more men with migraine suffer from PTSD than women

A recently published paper highlights that while the risk of post-traumatic stress disorder (PTSD) is more common in those with migraine than those without migraine irrespective of sex, the risk is greater in male migraineurs than female migraineurs. Study details are now available in Headache: The Journal of Head and Face Pain, published by Wiley-Blackwell on behalf of the American Headache Society.

In this paper, lead author B. Lee Peterlin and colleagues review the epidemiology of PTSD and migraine, underscoring the established sex differences. While individually both migraine and PTSD are more common in women than men, a recent study by Peterlin and colleagues—the only study to date to look at sex differences in the PTSD-migraine association—suggests that men with migraines had up to a four-fold greater odds of PTSD than females who experience migraine headaches. This finding suggests that sex hormones play an important role in the PTSD-migraine association.

The age of the traumatic life event resulting in PTSD may also be an important factor for the sex differences in the PTSD-migraine association. When a traumatic life event occurs before 13 years of age, the risk of depression is greater than the risk of PTSD; however, when the traumatic life event occurs after 12 years of age, the risk of PTSD is greater.37 Although the migraine population has a documented high prevalence of abuse, the peak age of vulnerability for childhood sexual abuse, is under 13 years of age. In contrast transportation accidents and combat, (two of the most common traumatic events reported by migraineurs with PTSD in one study), may be more commonly experienced by those older than 12 years of age. It is therefore possible that in the migraine population, sex differences in the type and age of traumatization contributes to the sex differences in the risk of PTSD.

Studies have also shown that the presence of PTSD in those with migraine is associated with greater headache-related disability than in migraine sufferers without PTSD. Dr. Peterlin explains, "The current data indicate that behavioral PTSD treatment alone can positively influence chronic pain conditions and disability. Therefore, physicians should consider screening migraine sufferers for PTSD, and men in particular. Further, in those migraineurs with PTSD, behavioral therapy should be considered, alone or in combination with pharmacological treatment." The authors suggest that further research investigating the sex differences in the association between PTSD and migraine is necessary to validate the sex differences found in their study, as well as to determine suitable treatment options in those migraineurs suffering with PTSD.

A second related article published this month in Headache also reviews sex and gender differences in those with headache. Todd Smitherman, PhD, from the University of Mississippi and Thomas Ward, MD, of the Dartmouth Medical School in New Hampshire reviewed extant medical literature to examine the psychosocial factors of gender and social role expectations, and coping strategies as they relate to sex and gender differences in headache pain.

A distinction was made in this paper between sex—the biologically-based indicators of male or female; and gender—"the traits and behaviors characteristic of and appropriate to members of each sexual category" (Unger, 1976) given that pain-related differences between men and women established in the medical literature cannot be reduced solely to biological determinants.

The authors suggest that women's pain experiences, multiple role responsibilities, and coping strategies likely influence the sex and gender differences in pain perception and response. "Gender-based differences are not strictly biological and important psychosocial issues are involved with headache pain as well," Dr. Smitherman concluded. "Further research of the impact of sex and gender on psychosocial variables may help clinicians tailor treatment plans that reduce pain and disability for headache patients."