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Downward Drift vs. Social Causation Theories for Migraine

Summary and Comment |
September 13, 2013

Downward Drift vs. Social Causation Theories for Migraine

  1. Mattias Linde, MD, PhD

A survey study suggests that factors associated with low socioeconomic status increase the incidence of migraine.

  1. Mattias Linde, MD, PhD

In most epidemiological studies examining migraine prevalence and socioeconomic status (SES), an inverse relationship has been found. One plausible explanation is that migraine leads to social selection — i.e., socioeconomic downward drift. The opposite theory is social causation — i.e., that factors associated with low SES increase the rate of new onset or duration of migraine. To test these hypotheses, investigators predicted that if social selection is at play, one would expect similar incidence and remission in different SES groups, whereas with social causation, one would expect a higher incidence or lower remission rate in groups with low SES. The analysis drew on data from a large, cross-sectional survey, the American Migraine Prevalence and Prevention Study. The researchers simulated a longitudinal cohort study based on participants' ages of onset of migraine, when they last had a migraine attack, and present age.

Participants were divided into three SES groups based on household income. The lowest income group had significantly higher incidence and prevalence of migraine than the other income groups. Remission rates did not differ among income groups. The authors conclude that these findings support the social causation hypothesis.

Comment

This study has major strengths — for instance, the large sample size and innovative analytical method. As always, there are also limitations such as potential confounders. Although the findings do not rule out social selection as a factor, I find it very interesting that migraine incidence appears to be the main mechanism behind the higher prevalence of migraine in lower socioeconomic groups. Low socioeconomic status is associated with physical and mental stress. The children of migraine patients with low household income are at clear risk for migraine and might be targeted in advance for prophylactic measures, such as regular exercise and stress avoidance, and counseling about seeking help in case of new-onset, bothersome headache.

Dr. Linde is Professor, Institute of Neuroscience of the Norwegian University of Science and Technology, and Consultant Neurologist, Norwegian National Headache Centre, both in Trondheim, Norway.

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