Migraine and the unpaid workload: Sex-specific patterns of domestic labor - insights from the SMILE project, a cohort study

Aim: Migraine substantially affects daily functioning, yet its impact on unpaid domestic labor, an essential and sex-structured component of home life, remains poorly characterized. Domestic tasks require sustained physical and cognitive effort and may be sensitive to illness-related functional limitations, particularly in households were gendered expectations shape baseline role allocation. Methods: As part of the SMILE project, 675 adults with migraine (544 females and 131 males) and 232 non-migraine controls (186 females and 46 males) completed a survey including demographics, MIDAS, DASS-21, and a ten-domain domestic labor module adapted from the Who Does What questionnaire. Participants rated the current division of each task and their preferred redistribution of responsibilities. Analyses were stratified by sex. Group differences were quantified using standardized mean differences (SMDs). Associations between MIDAS and chore scores were examined using Spearman correlations and multivariable linear regression adjusted for age and DASS-21 subscales. Results: Participants with migraine had substantial disability (median MIDAS 30 [IQR 15–64]; 65% severe), and a median of 10 headache days in the preceding three months [IQR 5–20]. Females with migraine reported greater partner involvement in several female-dominated tasks compared with controls, including cleaning after meals (mean 4.12 vs 3.47; SMD 0.32), laundry (3.16 vs 2.59; SMD 0.27), and general cleaning (3.59 vs 3.18; SMD 0.19). Males with migraine showed increased involvement in a different subset of chores, most notably trash disposal (3.42 vs 5.18; SMD 0.87). Females with migraine also expressed stronger preferences for increased partner involvement across multiple domains. Among males, MIDAS correlated with greater partner involvement (r up to 0.29), whereas among females, MIDAS showed weaker, more variable associations; regression models confirmed task-specific relationships. Conclusion: Migraine is associated with distinct sex-specific patterns in the structure and desired redistribution of domestic labor. These findings highlight household functioning as an overlooked dimension of migraine-related disability and fit within the SMILE Resource–Role Strain framework.