Migraine in adolescents: association with socioeconomic status and family history

The influence of socioeconomic status on the prevalence of migraine is unknown in adolescents. Accordingly, we investigated the prevalence of migraine in a large sample of adolescents by sociodemographic features.

A validated headache questionnaire was mailed to 120,000 households representative of the US population. All individuals in the household were interviewed (probands and their parents). We calculated sex-specific prevalence estimates of migraine in adolescents derived by age, race, urban vs rural residence, household income, region of the country, and parental status of migraine, using log-linear models.

A total of 32,015 adolescents were identified. Surveys were returned by 18,714 of them (58.4% response rate). The 1-year prevalence of migraine was 6.3% (5.0% in boys and 7.7% in girls). The prevalence was higher in girls than in boys older than 12 and in whites than African Americans. In families with an annual income lower than $22,500, the adjusted prevalence of migraine in adolescents without a parental history of migraine was 4.4%; in families earning $90,000 or more, it was 2.9% (OR = 0.49, 95% CI 0.38 to 0.63). In adolescents with a parental history of migraine, the prevalence in the lower vs the higher income group was 8.6% vs 8.4% (OR = 0.97, 0.81 to 1.15).

In adolescents with family history of migraine, household income does not have a significant effect, probably because of the higher biologic predisposition. In those without a strong predisposition, household income is associated with prevalence. This suggests social causation rather than social selection, highlighting the need for exploration of environmental risk factors related to low income and migraine and the search for specific comorbidities and stressors in this group.