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Episodic Migraine & Socioeconomic Status: Cause or Effect?

As a result of the large, groundbreaking American Migraine Prevalence and Prevention Study (AMPP) and other studies, we have known for some time there is a greater occurrence of Migraine among people with low socioeconomic status.

But this knowledge has always posed a “Which came first, the chicken or the egg?” quandary. In other words, do the situations associated with having low socioeconomic status make someone more likely to experience Migraine (social causation) or does living with Migraine cause the low socioeconomic status (social selection)? Using data from the AMPP study, researchers recently examined this important question with respect to episodic Migraine.

Researchers have believed both social causation and social selection are viable explanations. Since the onset of Migraine usually occurs in adolescence or young adulthood, we know this has a detrimental effect on the earning capability of Migraineurs (social selection). On the other hand, it is possible the stessors associated with low socioeconomic status make individuals prone to Migraine more likely to experience the condition (social causation).

The researchers assessed the AMPP data with the following ideas in mind:

  • If social selection is the explanation, Migraine incidence and remission rates would not vary by income category.
  • If social causation is the explanation, people in the lower income category would have higher incidence and lower remission rates when compared to higher income categories.

The research team believes its findings are consistent with the social causation theory of Migraine. Incidence and prevalence rates differed by income category. People in the bottom third of income were more likely to live with Migraine. In contrast, Migraine remission rates did not vary by income category.

Based on the results, the researchers believe:

  • Migraine onset may be more likely to be associated with external factors.
  • Migraine remission may be related to internal and/or genetic factors instead of external factors.

One major limitation of this study may lie in using income alone to determine the socioeconomic status of the research subjects. As discussed in an editorial accompanying this research study, it is more informative to use multiple factors to determine socioeconomic status to account for variability. For instance, people who despite having high levels of education have low incomes.

Further, chronic Migraine patients were excluded from this study. Thus, those whose income levels and socioeconomic status are most frequently and profoundly impacted by Migraine are not part of this study at all. However, the researchers chose not to include this group because of the small sample size of those with chronic Migraine in the original AMPP study.

While this study is certainly interesting and provides support for the idea that social causation plays an important role in Migraine, it does not settle the question of why people with low socioeconomic status are more likely than others to live with Migraine.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Walter F. Stewart, Jason Roy, and Richard B. Lipton. "Migraine prevalence, socioeconomic status and social causation." Published online before print August 29, 2013, doi: 10.1212/WNL.0b013e3182a43b32 Neurology 10. 212/WNL.0b013e3182a43b32 .
  2. B. Lee Peterlin and Ann I. Scher. " Migraine and the social selection vs causation hypotheses." Published online before print August 29, 2013, doi: 10.1212/WNL.0b013e3182a43ea7 Neurology 10.1212/WNL.0b013e3182a43ea7 .


  • lara
    6 years ago

    I think it has something to do with the fact that people who suffer from chronic migraine are simply not employable and I don’t mean that as a slight against people with migraine but against the way HR and businesses no longer want to hire anyone with a disability. Let’s face it, corporations have turned nasty since 2008.

    I have a degree (with honors) in computer science and I’m pursuing my bachelors in engineering. In addition, I have over ten years experience in software, firmware and hardware development.

    My resume should get me hired in an instant but my migraine history works against me. I have this nasty habit of full disclosure during an interview because.. hey – they’re gonna know in the first few weeks anyway!

    An employer who is serious about hiring the disabled would work with me and provide telecommuting and flexible hours, right? In IT and Development this wasn’t even an issue a couple years ago. I have had wonderful employers who didn’t even blink at remote access and flextime. In fact, they got more out of me by letting me work from home part of the week. Global companies could rely on me to answer email at all hours!

    Not so much anymore. Post 2008 any mention of disability accommodation in the way of telecommuting or flextime is shutdown as a “perk” and I’m met with some other “reason” as to why I am “wrong” for the job. It’s usually in the form of an insulting “compliment” such as “I’d get bored.” It doesn’t matter how qualified you are anymore. If you have any issue that sets you apart from the norm (and if you’re a woman in IT or development?) forget it. Your boss wants you to chained to desk 8-5 even if it is a determent to job performance.

    If I sound bitter? I am. Filing for disability at a rate that is a small fraction of what I am capable of making is severely humbling. I hope that once I have a second degree it might be enough to tempt one of the several tech firms here in Seattle but I’ll probably still hear the same line about being overqualified and bored…

    The really sad thing is that SSI has determined that I am “too skilled” and “too educated” to be disabled. As if pain is somehow influenced by experience and education. THIS is why migraine patients are poor. No matter what we do? We can’t get ahead. If someone with a computer science degree who is also pursuing an engineering degree can’t find work? We’re doomed.

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