OBJECTIVES: Migraine is a debilitating chronic disease that affects approximately 13% of the United States population.  Gender differences in migraine treatment have been studied; however, the results are often overlooked due to lack of controlling for selection bias.  The study aimed to investigate gender differences in migraine treatment, using propensity score-matched analyses.  METHODS: A retrospective population-based study was conducted by analyzing a national database from 2010 National Ambulatory Medical Care Survey.  All patient visits with a diagnosis of migraine were included.  A series of weighted descriptive analyses were used to estimate the prevalence of medications recommended in the American Neurology Association practice guidelines.  Multivariate logistic regression and Greedy 8 to 1 digit match were used to create propensity scores.  A propensity score weighted logistic regression model was fitted to compare the gender difference on migraine treatment while controlling for age, race, pay type, and physician specialty. All analyses utilized SAS PROCSURVEY applications and incorporated sample weights and standard errors.   RESULTS: Among 5.45 million outpatient visits that took place in 2010 with migraine diagnosis, female accounted for nearly four-times than male (79.8% vs. 20.2%).   Of these, 3.08 million visits (56.48%) received at least one abortive or prophylactic migraine prescription.  Prior to propensity-score matching, the socioeconomic characteristics of the two cohorts (with vs. without migraine pharmacotherapy) were significantly different (P<0.001).  After matching, there was no longer a significant difference between two cohorts (P>0.05).  Female received significant more migraine treatment than male (OR: 3.2, 95% CI: 1.137-8.932).  CONCLUSIONS: The assessment of gender differences in health care is challenging because of the potential biases that require careful adjustment.  This study successfully reduced selection bias by propensity score-matched methodology and concluded significant gender disparity in migraine pharmacotherapy.   This study also provides an empirical evident of undertreated migraine conditions in the US.