At what age do males typically experience their first migraine?

Age of First Migraine Onset in Males

The most common age of first migraine onset in males is during childhood, with peak incidence occurring between ages 5-11 years, specifically with migraine without aura peaking at 10-11 years and migraine with visual aura peaking at or before 5 years of age.

Age-Specific Patterns in Males

• For males with migraine with visual aura, incidence appears to peak at or before 5 years of age at a rate of 6.6/1,000 person-years 1
• For males with migraine without aura, the highest incidence occurs between 10-11 years of age at 10.1/1,000 person-years 1
• New cases of migraine become uncommon among males in their late 20s, showing a distinct early-life pattern 1
• The percentage of males with migraine decreases markedly from childhood to adulthood, making migraine predominantly a pediatric condition in males 2

Comparison with Female Patterns

• Female migraine onset typically occurs later than in males, with peak incidence of migraine with aura at 12-13 years and without aura at 14-17 years 1
• Unlike males, females continue to develop new-onset migraine well into their late 20s 1
• This gender difference contributes to the overall higher prevalence of migraine in adult women (18%) compared to men (6%) 3

Long-term Prognosis After Childhood Onset

• In a 10-year follow-up study of children diagnosed with migraine, 46% continued to experience migraine attacks, though with reduced frequency 4
• The frequency of attacks typically diminishes over time, with the rate of patients having at least one migraine attack per week falling from 37% to 8% over a 10-year period 4
• Age at first presentation to a headache center ≥12 years was the only significant factor associated with long-term chronic migraine (odds ratio = 3.0) 4

Clinical Characteristics of Migraine Across Age Groups

• Migraine in children and adolescents has different clinical features compared to adults 2
• In children under 18 years, migraine attacks may last 2-72 hours, whereas in adults the typical duration is 4-72 hours 5
• Pediatric migraine often presents with bilateral headache (rather than the classic unilateral pattern seen in adults) and less pulsating quality 2
• Gastrointestinal symptoms are commonly prominent in pediatric migraine 5

Diagnostic Considerations

• Diagnosis of migraine in children relies primarily on medical history, with modified criteria compared to adults 5
• The International Classification of Headache Disorders (ICHD-3) provides specific diagnostic criteria for migraine with and without aura 5
• At least 5 attacks fulfilling the criteria are required for definitive diagnosis of migraine without aura 5
• For migraine with aura, at least 2 attacks with specific aura characteristics are required 5

Understanding the early onset pattern of migraine in males is important for early diagnosis and intervention, as earlier treatment may lead to better long-term outcomes and potentially prevent progression to chronic migraine.