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

Abstract

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.

Keywords

migraine domestic labor sex roles sex differences functional disability work–family conflict household workload

Introduction

Migraine is a leading cause of disability worldwide and affects multiple domains of daily functioning.^1–3 Although its impact on paid work, burnout, and work–family conflict is well-established,^4–7 far less is known about how migraine influences participation in unpaid domestic labor. Evidence from other chronic conditions, such as rheumatoid arthritis, suggests that illness-related functional limitations extend into the domestic sphere, leading to reduced participation in household tasks and shifts in responsibility toward partners or other household members.^8,9

Household tasks, physically and cognitively demanding, repetitive, and strongly patterned by gender norms,^10–12 represent a significant component of daily life yet remain minimally examined in migraine research. While domestic activities are included in disability measures such as MIDAS, prior studies have not systematically investigated the structure, distribution, or gender patterns of household chores.

Previous SMILE analyses showed that migraine severity correlates with occupational burnout and work–family conflict,^6,7 suggesting that illness burden is expressed across interconnected family and work roles. Domestic labor likely represents another domain in which functional limitations are negotiated. Understanding how migraine relates to the division of household responsibilities is vital because these tasks shape overall functional load, influence family dynamics, and may interact with both symptom severity and psychosocial stressors. Examining domestic labor thus offers complementary insight into the lived experience of migraine, extending beyond traditional work-related outcomes.

In this study, we investigated sex-specific associations between migraine, current division of domestic chores, preferred allocation of responsibilities, and migraine-related disability. Using detailed data across ten chore domains, we compared individuals with and without migraine and assessed how chore patterns relate to symptom severity.

Methods

Study design and study population

This study was conducted as part of the SMILE project (Southern Israel Migraine Impact on Life Experiences), which investigates the broader personal and social impact of migraine among adults living in the southern district of Israel. The design and recruitment procedures have been previously described.^6,13

In brief, migraine patients aged ≥18 years were identified within the Clalit Health Services (CHS) database using physician-assigned ICD-9 migraine diagnoses and/or triptan dispensations, consistent with prior epidemiological studies. A comparison group without migraine was constructed from the same CHS population and matched to the migraine group on age (±5 years), sex, and primary clinic.

In 2021, a random sample of eligible adult (≥18 years) migraine and non-migraine participants was drawn from the CHS database. Potential participants were contacted by telephone by study personnel and invited to participate in the study. Overall, 1475 individuals with migraine were contacted, of whom 675 (46%) completed the survey, and 515 non-migraine individuals were contacted, of whom 232 (45%) completed the survey between February and July 2021. Participants received a link to an online questionnaire administered by an external survey company, which was blinded to participants’ migraine status. The survey company was responsible for data collection, monitoring responses, and issuing reminders to participants. The study flow is presented in Supplemental Figure 1. Participants who did not complete the domestic chore section of the questionnaire were excluded, no additional clinical exclusion criteria were applied, including comorbid conditions, consistent with the population-based design of the study.

Data collection

Data collection included demographic and health characteristics, migraine-related measures, psychological factors, and a dedicated module assessing domestic labor. Participants reported their age, sex, marital status, number of children, education level, smoking status, and self-rated health, following formats previously used in SMILE publications.

Migraine severity was evaluated using the Migraine Disability Assessment (MIDAS). Participants also provided the number of monthly headache days, headache intensity on a scale of 1 to 10, and information on the use of acute and preventive migraine medications.¹⁴

Psychological symptoms were evaluated using the Depression, Anxiety, and Stress Scale – 21 items (DASS-21). This instrument includes three seven-item subscales that measure depression, anxiety, and stress over the preceding week.¹⁵

The domestic labor division was assessed using items adapted from the Who Does What (WDW) questionnaire, a well-established instrument developed initially by Cowan and colleagues to evaluate the distribution of family work between partners.¹⁶ The WDW focuses on concrete, everyday tasks that reflect the functional organization of household life. In the present study, responsibility for ten core household domains was assessed, including meal preparation, cleaning after meals, general cleaning, laundry, grocery shopping, paying bills, coordinating family social activities, house maintenance, car maintenance, and trash disposal.

For each task, participants indicated the current division of responsibility using a nine-point scale, with lower values indicating they carried out most of the tasks and higher values indicating greater involvement by their partner. Participants then rated their preferred division of responsibility using the same scale, allowing direct comparison between actual and desired arrangements. A delta score was calculated by subtracting the current score from the desired score, so that positive values reflected a desire for more partner involvement and negative values reflected a preference for assuming more responsibility themselves.

To support visual interpretation, each domain was empirically categorized as female-dominated, mixed, or male-dominated based on the mean division-of-labor scores observed in the non-migraine control group. These categories were data-driven and used solely for descriptive organization and visual presentation, without influencing any statistical analyses.

Statistical analysis

The primary outcomes in this study were current and desired household chore division; both derived from the “Who Does What” (WDW) questionnaire. The primary exposures were migraine diagnosis (binary) and migraine-related disability as measured by the MIDAS score (continuous). All analyses were stratified by sex.

The sample size (675 participants with migraine and 232 non-migraine controls) was determined as part of the SMILE study design to ensure adequate statistical power (80%) to detect small-to-moderate effect sizes at a significance level of 0.05, based on assumptions derived from prior analyses within this cohort.⁶

Descriptive statistics were computed using means and standard deviations (SD) for normally distributed variables, medians and interquartile ranges [Q1, Q3] for skewed data, and proportions for categorical variables. To evaluate the magnitude of group differences independent of sample size, standardized mean differences were calculated for all baseline comparisons.

The division of household labor was analyzed at both the level of individual chore domains and the level of composite outcomes. For each of the ten household domains, current division-of-labor scores and desired division scores were collected, and a delta score representing desired change was calculated.

To provide context and support visual interpretation, chore domains were empirically classified as female-dominated, mixed, or male-dominated based on their mean division-of-labor scores in the non-migraine comparison group. This classification was used only for descriptive ordering within the figures. Radar plots were then generated to compare migraine and non-migraine participants on both current division and desired change for each domain, stratified by sex.

Associations between migraine severity and chore-division patterns were examined in two steps. First, univariate associations were explored using Spearman's rank correlation between WDW scores (both current and delta) and migraine severity metrics, in the whole cohort and stratified by sex. Second, multivariable linear regression models were fitted for each household chore domain, with the division-of-labor score (WDW score) as the dependent variable and migraine severity (MIDAS score, continuous) as the primary independent variable. All models were stratified by sex and adjusted for age, depression, anxiety, and stress (DASS-21 subscales). Higher WDW scores indicate greater partner involvement in the task.

All analyses were performed using R version 4.4.1 in the RStudio 2024.04.2 environment (R Foundation for Statistical Computing, Vienna, Austria; Posit PBC, Boston, MA, USA), and a two-sided p-value of <0.05 was considered statistically significant. The Soroka Medical Center Institutional Review Board approved the study protocol. This study is reported in accordance with the STROBE guidelines for observational studies.

Results

A total of 675 participants with migraine (544 females and 131 males) and 232 non-migraine controls completed the domestic labor module. The median age of participants with migraine was 43 years [IQR 34–54], compared with 49 years [IQR 39–66] in controls. Approximately 80% of participants in both groups were female. Most participants were married (60% in the migraine group and 63% in controls), with a mean of approximately 3 children per participant. Post-secondary education was reported by 36% of participants with migraine and 44% of controls. Self-rated health was similar between groups. (Table 1).

Table 1.

Demographic, migraine-related characteristics and patient-reported outcome measures (PROMs).

	Migraine			Non - migraine	SMD	P-value
	Female sex (N = 544)	Male sex (N = 131)	Total cohort (N = 675)	Total cohort (N = 232)	SMD	P-value
	Demographic Characteristics
Sex- Female, %	544 (100.0%)	0 (0.0%)	544 (80.6%)	186 (80.2%)	0.011	0.965
Age - Median [Q1, Q3]	43.0 [33.0, 55.0]	43.0 [35.0, 51.0]	43.0 [34.0, 54.0]	49.0 [39.0, 66.0]	0.591	<0.001
Marital status – Married, %	312 (57.4%)	93 (71.0%	405 (60.0%)	146 (62.9%)	0.189	0.176
Number of Children - Mean (SD)	2.81 (1.38)	3.09 (1.12)	2.87 (1.34)	3.31 (1.57)	0.302	0.004
Education Level - Post-Secondary Education, %	203 (37.3%)	40 (30.5%)	243 (36.0%)	103 (44.4%)	0.372	0.001
Self-Rated Health Status (scale range: 1–10, with 1 being poor and 10 being excellent) - Mean (SD)	7.52 (2.02)	7.31 (1.85)	7.48 (2.05)	7.85 (1.81)	0.190	0.367
	Migraine-related Characteristics
Onset Age - Median [Q1, Q3]	19.0 [15.0, 27.0]	20.0 [16.0, 29.0]	20.0 [15.0, 27.0]
Diagnosis Age - Median [Q1, Q3]	24.0 [18.0, 30.0]	24.0 [18.5, 30.0]	24.0 [18.0, 30.0]
Treated by Migraine Preventive Drugs %	215 (39.5%)	48 (36.7%)	263 (39.0%)
Headache Days in Last Three Months (MIDAS A) -	10.0 [4.25, 20.0]	10.0 [5.0, 20.0]	10.0 [5.0, 20.0]
Median [Q1, Q3]
MIDAS Score - Median [Q1, Q3]	30.0 [15.0, 64.0]	26.0 [11.0, 56.0]	30.0 [15.0, 64.0]
MIDAS Score groups
Little or No Disability (0–5)	55 (10.1%)	22 (16.8%)	77 (11.4%)
Mild Disability (6–10)	31 (5.7%)	9 (6.9%)	40 (6.0%)
Moderate Disability (11–20)	94 (17.3%)	25 (19.1%)	119 (17.6%)
Severe Disability (21+)	364 (66.9%)	75 (57.2%)	439 (65.0%)
Mean Triptan pills per month - Mean (SD)	3.7 (2.9)	2.6 (2.4)	3.4 (2.1)
1–4	387 (71.1%)	101 (77.1%)	488 (72.3%)
5–9	97 (17.8%)	19 (14.5%)	116 (17.2%)
10+	60 (11.0%)	11 (8.4%)	71 (10.5%)
	DASS-21
Depression Symptoms Scale (0–3) - Mean (SD)	0.847 (0.799)	0.946 (0.870)	0.864 (0.811)	0.664 (0.712)	0.262	0.045
Anxiety Symptoms Scale (0–3) - Mean (SD)	0.770 (0.776)	0.808 (0.781)	0.776 (0.776)	0.693 (0.772)	0.107	0.265
Stress Symptoms Scale (0–3) - Mean (SD)	1.22 (0.867)	1.23 (0.924)	1.23 (0.876)	0.931 (0.819)	0.348	0.006

Among those with migraine, the median MIDAS scores were 30.0 [IQR 15.0–64.0] in females and 26.0 [IQR 11.0–56.0] in mal es, and 65% met criteria for severe disability. Median headache days in the preceding three months were 10 [IQR 5–20]. Employment-related characteristics were broadly similar between migraine and non-migraine participants. The majority of participants in both groups were currently employed (89.9% vs. 90.9%). Weekly work hours were comparable (mean 35.1 vs. 32.7 h), as were years of experience in the current workplace (mean 10.0 vs. 13.8 years) and commuting time (mean 29.6 vs. 25.7 min).

Distinct patterns were observed across the ten chore domains (Table 2). In female-dominated tasks, such as general cleaning, laundry, and cleaning after meals, females with migraine reported higher division-of-labor scores, indicating greater partner involvement and reduced personal responsibility compared with non-migraine females. For example, differences were observed in cleaning after meals (mean 4.12 vs. 3.47; SMD 0.317) and laundry (mean 3.16 vs. 2.59; SMD 0.272).

Table 2.

Current division of domestic chores by sex and migraine status.

Chore	Female migraine (N = 544)	Female non- migraine (N = 186)	SMD	P- value	Male migraine (N = 131)	Male non-migraine (N = 45)	SMD	P- value
Meal preparation- Mean (SD)	3.33 (2.11)	3.33 (2.09)	0.004	0.901	5.56 (2.26)	5.91 (2.26)	0.155	0.691
Cleaning after meal- Mean (SD)	4.12 (2.06)	3.47 (2.05)	0.317	0.096	5.26 (2.04)	6.45 (2.07)	0.582	0.071
House maintenance- Mean (SD)	6.31 (2.46)	5.63 (2.71)	0.262	0.113	2.66 (2.36)	3.27 (2.20)	0.269	0.217
General cleaning- Mean (SD)	3.59 (2.16)	3.18 (2.13)	0.191	0.224	5.88 (1.92)	6.00 (2.00)	0.061	0.871
Taking out trash- Mean (SD)	6.18 (2.34)	5.02 (2.34)	0.497	0.001	3.42 (2.39)	5.18 (1.60)	0.866	0.013
Groceries & shopping- Mean (SD)	4.47 (2.39)	4.51 (2.27)	0.019	0.795	4.48 (2.74)	5.27 (2.37)	0.309	0.338
Bill payments- Mean (SD)	5.18 (2.48)	5.51 (2.46)	0.134	0.411	4.48 (2.76)	3.91 (3.02)	0.198	0.463
Laundry- Mean (SD)	3.16 (2.16)	2.59 (2.02)	0.272	0.083	6.24 (2.40)	6.36 (2.34)	0.052	0.924
Family social coordination- Mean (SD)	4.21 (2.00)	4.38 (1.90)	0.085	0.545	5.66 (1.92)	4.82 (2.27)	0.400	0.3
Car maintenance & repairs- Mean (SD)	6.51 (2.75)	6.65 (2.58)	0.053	0.974	3.06 (2.70)	4.00 (3.16)	0.320	0.456
Total Score- Mean (SD)	4.70 (1.29)	4.48 (1.11)	0.184	0.261	4.67 (1.30)	5.12 (0.782)	0.418	0.179

Males with migraine showed increased participation in a different subset of tasks. The most pronounced differences were observed in cleaning after meals (mean 5.26 vs. 6.45; SMD 0.582) and in trash disposal (mean 3.42 vs. 5.18; SMD 0.866). Male-dominated tasks, such as car maintenance and bill payments, showed minor or inconsistent differences by migraine status. In the overall composite domestic labor score, females with migraine reported slightly higher partner involvement compared with non-migraine females (mean 4.70 vs. 4.48; SMD 0.18), while males with migraine reported lower partner involvement compared with non-migraine males (mean 4.67 vs. 5.12; SMD 0.42).

Radar plots (Figure 1) illustrate these sex-stratified patterns and highlight the arrangement of chore domains according to sex -dominant categories defined in the control group. Female-dominated tasks showed the greatest divergence by migraine status in both sexes.

Desired changes (delta values) demonstrated additional sex-specific patterns (Supplemental Table 1). Females with migraine expressed stronger preferences for increased partner involvement in several tasks, including cleaning after meals (SMD 0.298), laundry (SMD 0.200), and car maintenance (SMD 0.327). Among males, desired changes were heterogeneous; some domains showed minimal differences by migraine status, whereas others, such as meal preparation and general cleaning, showed moderate standardized differences.

Correlations between MIDAS scores and the current division of chores were more pronounced within female-dominated domains (Figure 2). Among females, higher MIDAS scores were associated with higher partner involvement across several tasks, including laundry (r = 0.11), and meal preparation (r = 0.16). Males demonstrated associations with higher partner involvement for meal preparation (r = 0.23), cleaning after meals (r = 0.29), and car maintenance (r = 0.23). Additional analyses examined the association between headache frequency (number of headache days in the past three months) and domestic labor patterns (Supplemental Table 2). Overall, correlations were modest and domain specific.

Multivariable regression models adjusting for age and DASS-21 scores (Table 3) showed task-specific associations. In these models, β coefficients represent the change in the division-of-labor score associated with increasing migraine severity, with positive values indicating greater partner involvement. Among females, higher MIDAS scores were associated with greater partner involvement in meal preparation (β = 1.5, 95% CI 0.29–2.8) and general cleaning (β = 1.3, 95% CI 0.01–2.6). Among males, point estimates were generally positive but imprecise. In sensitivity analyses incorporating employment-related variables into the multivariable models, no meaningful changes in the observed associations were identified.

Table 3.

Current division of domestic chores vs. migraine severity by sex; multi-variable linear regression model result.

	Beta	95% CI ¹	p-value	Beta	95% CI ¹	p-value
	Meal preparation			Cleaning after meal
Female	1.5	0.29, 2.8	0.017	0.68	−0.56, 1.9	0.3
Male	1.3	−1.1, 3.6	0.3	1.3	−0.76, 3.4	0.2
	House maintenance			General cleaning
Female	0.09	−1.4, 1.6	0.9	1.3	0.01, 2.6	0.048
Male	1.7	−0.64, 4.0	0.2	0.94	−1.1, 3.0	0.4
	Taking out trash			Groceries & shopping
Female	0.55	−0.86, 2.0	0.4	−0.16	−1.6, 1.3	0.8
Male	0.68	−1.7, 3.1	0.6	−0.91	−3.8, 2.0	0.5
	Bill payments			Laundry
Female	−0.33	−1.8, 1.2	0.7	0.90	−0.41, 2.2	0.2
Male	1.1	−1.8, 4.0	0.4	−1.2	−3.7, 1.4	0.4
	Family social coordination			Car maintenance & repairs
Female	0.03	−1.2, 1.2	>0.9	0.99	−0.69, 2.7	0.2
Male	−0.86	−2.9, 1.2	0.4	1.8	−0.90, 4.5	0.2

β coefficients represent the change in division-of-labor (WDW) score per unit increase in MIDAS score; higher values indicate greater partner involvement.

In the overall division-of-labor summary (Figure 3), both sexes showed positive associations between MIDAS scores and greater reliance on partners, with steeper slopes observed among females. Desired changes exhibited negative associations with MIDAS, indicating smaller differences between current and preferred task distribution at higher levels of migraine severity.

Discussion

In this population-based cohort, migraine was associated with apparent sex-specific differences in participation in domestic labor and in preferences for how household tasks should be allocated. Females with migraine reported greater partner involvement in many routine domestic chores, particularly in traditionally female-dominated domains, compared with females without migraine. Males with migraine showed increased participation in a different subset of tasks. Desired redistribution also varied: females more frequently expressed preferences for increased partner involvement, whereas males demonstrated more modest or heterogeneous preferences. Together, these patterns indicate meaningful variation in how domestic labor is structured within households that include individuals with migraine.

Associations between migraine severity and household task patterns differed by both sex and task type. Stronger correlations between MIDAS scores and the division of labor were observed in female-dominated tasks. In contrast, male-dominated tasks showed weaker or inconsistent associations for both sexes. These findings suggest that certain household responsibilities may be more sensitive to illness burden than others, although the cross-sectional design does not allow determination of temporal or directional relationships. Depression, anxiety, and stress were included as covariates in the adjusted models. In exploratory analyses, higher levels of these psychological symptoms were consistently associated with lower participation in household tasks across both sexes and irrespective of migraine status, without clear evidence of effect modification. Accordingly, these variables were modeled as confounders rather than interaction terms.

These observations extend existing evidence that domestic activities represent an important area of functional difficulty for individuals with migraine.¹⁷ Surveys such as MAZE and Eurolight have reported reduced ability to perform household tasks, substantial productivity loss in the home environment, and notable burden on partners and family members.^18,19 The present study adds domain-level and sex-specific resolution to this literature and incorporates participants’ preferred chore redistribution as an independent indicator of perceived household needs.

Within the broader context of the SMILE project, these findings align with previously reported associations between migraine severity, occupational burnout, and work–family conflict. Viewed together, these three studies suggest that the impact of migraine is reflected across several interconnected domains of daily functioning.

To integrate these observations, we propose an interpretive model, the SMILE Resource–Role Strain (SMILE-RRS) Framework, which draws on the chronic illness trajectory framework,^20,21 role strain theory,²² and conservation-of-resources theory.^23,24 The SMILE-RRS Framework conceptualizes household, occupational, and family responsibilities as interdependent roles in which fluctuations in functional capacity may influence perceived strain and resource demands.

Notably, the SMILE-RRS Framework explicitly incorporates sex differences and gendered role expectations, viewing household, occupational, and family responsibilities as interdependent domains in which functional capacity, societal norms, and gendered divisions of labor jointly shape perceived strain and resource demands (Figure 4). Although the present data cannot establish causal pathways, the sex-specific domestic labor patterns observed here are consistent with the types of resource role dynamics described in this model.

Sex differences further reinforce this interpretation. Females, who often carry disproportionate responsibility for the organizational “mental load” of household management, reported shifting some practical tasks to partners as migraine severity increased, yet likely continued to shoulder substantial cognitive and emotional responsibilities. Males with migraine, by contrast, frequently reported increased personal involvement in several chores while simultaneously exhibiting higher levels of work–family conflict and burnout, suggesting that domestic duties may accumulate on top of sustained work obligations.

These gendered pathways illustrate how chronic illness interacts with social norms and household structures, shaping how individuals redistribute or absorb daily demands. Recognizing these dynamics may help identify opportunities for targeted support in both household and occupational contexts.^25,26

These findings have several practical implications. Clinicians may benefit from routinely inquiring about domestic responsibilities, as household workload contributes to overall strain and may influence coping, fatigue, and perceived disability. From a public health perspective, unpaid domestic labor constitutes a substantial portion of daily activity yet is rarely incorporated into disability assessments or burden-of-disease calculations. Acknowledging domestic labor as a relevant functional domain may yield a more comprehensive understanding of migraine-related impairment and highlight sex-specific support needs.

Strengths of this study include its large sample size, detailed assessment of ten household domains, use of validated measures, and sex-stratified analyses. Limitations include the cross-sectional design, which precludes causal inference and limits the ability to determine the directionality of the observed associations, and reliance on self-reported chore participation, which may be influenced by subjective perception rather than objective behavior. Although several associations reached statistical significance, effect sizes were generally modest, and findings should be interpreted cautiously within the broader clinical and social context. The absence of partner-reported data further limits the ability to validate reported task distribution. In addition, unmeasured factors related to household structure and role allocation, including traditional patterns of responsibility, may act as potential confounders. Although employment-related variables were broadly similar between groups and did not materially affect the results in sensitivity analyses, residual confounding cannot be excluded. Selection bias is also possible, as participation in survey-based studies may be influenced by symptom burden or engagement with healthcare. Finally, cultural variability in domestic labor norms may limit generalizability to other populations.

Future research should incorporate longitudinal and dyadic designs to clarify how household functioning evolves in relation to symptom fluctuations and treatment. It should consider ecological momentary assessment or passive activity monitoring to capture domestic functioning with greater temporal resolution. Although migraine burden was assessed using continuous measures, including MIDAS scores and headache frequency, we did not classify participants according to formal ICHD-based categories (e.g., episodic vs chronic migraine), which may provide additional clinical resolution in future studies

In summary, domestic labor represents an important and previously underexamined dimension of the lived experience of migraine. While causal direction cannot be inferred, the sex-specific differences identified here underscore the relevance of household functioning, alongside occupational and psychosocial domains, when evaluating the broader impact of migraine on daily life. Integrating these findings within the SMILE-RRS Framework provides a cohesive lens through which to understand how migraine may be reflected across the diverse roles individuals occupy within the household and family system.

Public Health relevance

In a population-based cohort of 675 adults with migraine and 232 controls, domestic labor patterns differed by sex.

Females with migraine reported greater involvement in female-dominated household tasks, whereas males showed increased participation in distinct domains.

Migraine severity correlated with task-specific partner reliance, particularly among females.

·Domestic labor emerges as an overlooked dimension of migraine-related disability.

Supplemental Material

sj-docx-1-cep-10.1177_03331024261464573 - Supplemental material for Migraine and the unpaid workload: Sex-specific patterns of domestic labor - insights from the SMILE project, a cohort study

Supplemental material, sj-docx-1-cep-10.1177_03331024261464573 for Migraine and the unpaid workload: Sex-specific patterns of domestic labor - insights from the SMILE project, a cohort study by Yair Zlotnik, Ido Peles, Shaked Sharvit, Michal Gordon, Victor Novack, Ronit Waismel-Manor and Gal Ifergane in Cephalalgia

Supplemental Material

sj-docx-2-cep-10.1177_03331024261464573 - Supplemental material for Migraine and the unpaid workload: Sex-specific patterns of domestic labor - insights from the SMILE project, a cohort study

Supplemental material, sj-docx-2-cep-10.1177_03331024261464573 for Migraine and the unpaid workload: Sex-specific patterns of domestic labor - insights from the SMILE project, a cohort study by Yair Zlotnik, Ido Peles, Shaked Sharvit, Michal Gordon, Victor Novack, Ronit Waismel-Manor and Gal Ifergane in Cephalalgia

Supplemental Material

sj-jpeg-3-cep-10.1177_03331024261464573 - Supplemental material for Migraine and the unpaid workload: Sex-specific patterns of domestic labor - insights from the SMILE project, a cohort study

Supplemental material, sj-jpeg-3-cep-10.1177_03331024261464573 for Migraine and the unpaid workload: Sex-specific patterns of domestic labor - insights from the SMILE project, a cohort study by Yair Zlotnik, Ido Peles, Shaked Sharvit, Michal Gordon, Victor Novack, Ronit Waismel-Manor and Gal Ifergane in Cephalalgia

Footnotes

ORCID iDs

Yair Zlotnik

Ido Peles

Shaked Sharvit

Ronit Waismel-Manor

Gal Ifergane

Consent to participate

We confirmthat guidelines on patient consent have been met and any details of informed consent obtained are indicated within the text of the submitted manuscript.

Consent for publishing

The authors agree that if accepted, the article publishes with Cephalalgia.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Declaration of conflicting interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Gal Ifergane has received consulting fees and honoraria from Teva, Novartis, Eli Lilly, Pfizer, AbbVie, Organon, and Lundbeck. Gal Ifergane has received research support from Teva and Pfizer.

Yair Zlotnik has received consulting fees and honoraria from Abbvie, Medison and Teva; and has received educational travel bursaries from Abbvie and Teva.

Ethical considerations

We confirm Ethical Committee approval was sought where necessary and is acknowledged within the text of the submitted manuscript.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Teva Pharmaceutical Industries.

Open practices

Not applicable.

Supplemental material

Supplemental material for this article is available online.

References

Lipton

Bigal

Diamond

, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007; 68: 343–349.

Stovner

Nichols

Steiner

, et al. Global, regional and national burden of migraine and tension-type headache. Lancet Neurol 2018; 17: 954–976.

Burch

Buse

Lipton

. Migraine: epidemiology, burden, and comorbidity. Neurol Clin 2019; 37: 631–649.

Buse

Pozo-Rosich

Dupont-Benjamin

, et al. Impact of headache frequency and preventive medication failure on quality of life, functioning, and costs among individuals with migraine across several European countries: need for effective preventive treatment. J Headache Pain 2023 Aug 24; 24: 15.

Aydinlar

Bozkurt

Senel

, et al. Factors negatively affecting a migraine-friendly workplace in healthcare. Int J Occup Saf Ergon 2026; 32: 572–578.

Peles

Sharvit

Zlotnik

, et al. Migraine and work - beyond absenteeism: migraine severity and occupational burnout - A cohort study. Cephalalgia 2024 Oct; 44: 3331024241289930.

Peles

Sharvit

Steen

, et al. Invisible burdens: gender-specific associations between migraine and work-family conflict: insights from the SMILE project - a cohort study. Cephalalgia 2025 Aug; 45: 3331024251352533.

Leino

Tuominen

Pirilä

, et al. Effects of rheumatoid arthritis on household chores and leisure-time activities. Rheumatol Int 2015; 35: 1881–1888.

Albani

Toska

Togas

, et al. Burden of caregivers of patients with chronic diseases in primary health care: a cross-sectional study in Greece. Nurs Rep 2024; 14: 1633–1646. Published 2024 Jul 3.

10.

Román

Ophir

. Housework time and task segregation. Demogr Res 2024 Jan 1; 50: 503–514.

11.

Aviv

Waizman

Kim

, et al. Cognitive household labor: gender disparities and consequences for maternal mental health and wellbeing. Arch Womens Ment Health 2025 Feb; 28: 5–14.

12.

European Institute for Gender Equality. Gender differences in household chores [Internet], https://eige.europa.eu/publications-resources/toolkits-guides/gender-equality-index-2021-report/gender-differences-household-chores?language_content_entity=en (n.d, accessed 28 November 2025).

13.

Peles

Asla

Abayev

, et al. Migraine epidemiology and comorbidities in southern Israel: the SMILE project. J Headache Pain 2022; 23: 60.

14.

Stewart

Lipton

Whyte

, et al. Reliability and validity of the Migraine Disability Assessment (MIDAS) questionnaire. Neurology 1999; 53: 988–994.

15.

Lovibond

. The structure of negative emotional states: comparison of the DASS and BDI. Behav Res Ther 1995; 33: 335–343.

16.

Cowan

. Who does what when partners be come parents: implications for men, women, and marriage. Marriage Fam Rev 1988; 12: 105–131.

17.

Buse

Lipton

Hall

, et al. Family impact of migraine: development and validation of the IMPAC scale. Headache 2020; 60: 583–597.

18.

Steiner

Stovner

Katsarava

, et al. The Eurolight project: the impact of primary headache disorders in Europe. J Headache Pain 2014; 15: 31.

19.

MacGregor

Brandes

Eikermann

. Migraine prevalence and treatment patterns: the global Migraine and Zolmitriptan Evaluation (MAZE) survey. Headache 2003; 43: 19–26.

20.

Corbin

Strauss

. A nursing model for chronic illness management based upon the trajectory framework. Sch Inq Nurs Pract 1991; 5: 155–174.

21.

Thorne

Paterson

. Shifting images of chronic illness. Image J Nurs Sch 1998; 30: 173–178.

22.

Goode

. A theory of role strain. Am Sociol Rev 1960; 25: 483–496.

23.

Hobfoll

. Conservation of resources: a new attemptatconceptualizing stress. Am Psychol 1989; 44: 513–524.

24.

Hobfoll

. Conservation of resources theory: its implications for stress, health, and resilience. In: Folkman

(ed.) The Oxford handbook of stress, health, and coping. Oxford, England, United Kingdom: Oxford University Press, 2012, pp.127–147.

25.

Vetvik

MacGregor

. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol 2017; 16: 76–87.

26.

Verdonk

Seesing

de Rijk

. Gendered illness experiences: a feminist analysis. Soc Sci Med 2008; 67: 1470–1479.

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