Invisible burdens: Gender-specific associations between migraine and work–family conflict: Gender-specific associations between migraine and work–family conflict: Insights from the SMILE project – a cohort study

Background: Migraine, a neurovascular disorder that affects quality of life, with peak prevalence during individuals’ most productive working years. Work–family conflict (WFC), a well-documented source of stress, occurs when work and family responsibilities interfere with each other. While migraine has been associated with occupational impairment, its association with WFC remains underexplored. The present study examines the association between migraine diagnosis, severity and WFC, stratified by gender. Methods: This study analyzed data from the SMILE cohort, a subset of the Negev Migraine Cohort. Participants with and without migraine were recruited and completed a structured questionnaire assessing WFC. The main exposures were migraine diagnosis and severity, measured using the Migraine Disability Assessment (MIDAS) score. The primary outcome was WFC. Covariates included sociodemographic characteristics, employment factors, and psychological distress (Depression, Anxiety and Stress Scale – 21 Items (DASS-21)). Statistical analyses involved multivariable gamma generalized linear mode regression models and quantile regression to examine associations, adjust for potential confounders and effect modification by gender. Results: In total, 675 migraine patients and 232 non-migraine participants were included in the study; 80.6% of migraine patients were female. Severe disability (MIDAS score ≥21) was reported by 65.0% of migraine patients, with employment rates of 89.2% for females and 93.1% for males. Migraine patients worked longer hours per week (median 40.0 vs. 36.0 hours for females, and 48.0 vs. 42.0 hours for males), and were more likely to work over 42 hours per week (18.2% vs. 7.0% for females and 32.8% vs. 8.7% for males, standardized mean difference=0.487). Migraine diagnosis was associated with higher Work To Family and Family To Work strain-based conflict scores among males (β=0.43, 95% confidence interval=0.06–0.78, p=0.03 and β=0.35, 95% 95% confidence interval=0.03–0.66, p=0.04, respectively); however, no statistically significant associations were observed among female. Higher migraine severity (MIDAS) was correlated with greater WFC, with the effect more pronounced at higher levels of migraine disability and more strongly associated with men (p<0.01 for all). Conclusions: Migraine is associated with higher WFC, especially in strain-based domains, with a stronger effect in men. Greater migraine severity further amplifies this conflict. These findings emphasize the need for workplace and clinical strategies to support migraine patients in managing work–life balance.