Gender differences in the experience of headache

Since 1940 numerous studies have shown that women report higher rates of symptoms, illness, disability and medical care utilization than men. The present analysis addresses gender differences in headache, with a focus on symptom frequency and associated pain and duration of each subject's most recent headache attack experienced within 4 weeks of interview. A random sample of 10,167 Washington County, Maryland residents (ages 12-29 years) were administered a standardized telephone interview in a large epidemiologic study of headache during 1986-1987. Among the respondents, 6347 described one or more headaches occurring within 4 weeks of the interview. Women reported few specific symptoms more frequently than men, and the relative rankings of the symptoms were nearly identical for each gender (rs=0.98). Estimated pain associated with each subject's headache and the duration of the attack were systematically greater for women than men. Although the relative rankings of symptoms by associated pain were very similar (rs=0.90), the correlation for the ranking of symptoms for duration by gender was less strong (rs=0.59). Women were significantly more likely to report recent headache-related disability and to seek health care services for their headaches, even after adjusting for headache severity. The results suggest that a strong interplay of an underlying physiological difference with socially determined role perceptions and illness orientations lead to greater reporting of symptoms by women.