I used to be very hurt when DH did nothing or very little for my birthdays.
I am an only child and I admit, I was extremely spoiled. My parents always made a "big deal" over my birthdays, with a card, cake, special dinner, gifts. Then I got married.

DH grew up in a totally different lifestyle than I did, and birthdays were not all that special.
It bothered me for years, but over time I realized he wasn't going to change. And I had a heart-to-heart talk with myself over it and realized he is a great husband in oh so many ways. I wouldn't trade him for the world.
And now that I'm older gifts don't really mean all that much to me anymore. What we do now is go out to dinner, just the two of us, to the restaurant of my choice. I enjoy that more, dinner out and spending time together, than a gift. Sometimes he'll get me a card, if he happens to be in town and thinks of it. But more times than not he doesn't. It just doesn't bother me anymore.