The Silent Minority
Because migraine is often seen as a “women's issue,” male sufferers rarely get the attention, or the research effort, that goes into female migraine. However, male sufferers require abortive and preventative treatment in the same manner that women do. Migraine occurs in men who have relatives with migraines, and men and women have similar migraine triggers.
It is never wise to ignore migraine pain, although many men do it. Men in American society are traditionally expected to “tough it out” more than women. They tend to seek less treatment for headache and, when they do, they tend to follow up with fewer specialists for migraine pain.
While working through the pain does allow people to maintain some amount of normalcy in their routine, quality of life will ultimately be affected in the presence of persistent, spontaneous pain. Job performance can suffer, as can one's relationships with friends and family. The longer head pain is ignored, the longer it may take to diagnose and treat it. Longer absences from work mean risking losing one's job, so ultimately it saves time, money, and personal wellbeing to pay attention to headaches as they occur.
Migraines are thought to be triggered by cortical spreading depression, or CSD, a wave of electrical activity in the brain. Animal studies have demonstrated that in males, the threshold for triggering CSD is much higher than that for females — about three times higher — perhaps suggesting an explanation for the migraine gender gap.
One migraine diagnosis more common in men than women is a phenomenon known as the “silent migraine,” also called an acephalgic or migraine aura without headache. This specific type of migraine episode is characterized by visual disturbances, aura, slurred speech and other symptoms, but generally does not present with a headache. Men are considerably more likely to suffer from this than women.
While silent migraine is typically benign and not linked to any serious health consequences, it can disrupt work and social activities and impact quality of life. Silent migraine is notoriously difficult to diagnose. Without the hallmark symptom of the headache, silent migraine is often confused with a variety of other neurological and health problems, including stroke, Ménière's disease, and hypoglycemia. It has also been shown that a large number of migraine sufferers (as many as 20 percent) have had at least one silent migraine episode.
The best way for men to accurately have an acephalgic migraine diagnosed is with a solid medical history. It is crucial for men to keep an accurate headache diary that records all symptoms, as acephalgic migraine diagnosis relies on accurate notation of symptoms. Writing down the symptoms, time it occurred, and pain scale can be immensely useful to a general practitioner or specialist because a continued diary enables them to see patterns.
Another type of migraine that occurs disproportionately in young men is called an ophthalmic migraine. This migraine variation is related to what is called a retinal or ocular migraine. The ocular migraine is a type of migraine that presents with visual anomalies where there is eye pain and temporary blindness. There may or may not be a headache associated with an eye migraine.
Chapter 1 has more information on silent and ophthalmic migraine variants.
The retinal blindness from an ophthalmic migraine generally resolves fairly quickly, usually within an hour, but requires the same treatment as a typical migraine. Migraineurs who encounter ophthalmic migraines should always consult an ophthalmologist to make sure there is no other medical reason for vision problems.
