What’s the link? Falling Incomes and Migraine

According to recent reports from the Census Bureau, incomes are down across the board and poverty is on the rise. But what, if anything, does the recession have to do with migraine?

Social scientists have known for decades that socioeconomic status (SES) is a very strong predictor of health status. People who fall into a low SES group are more likely to be sick than people who are part of a high SES group. People who have money, higher education levels and — importantly — jobs, are in a better position to take care of themselves. They can afford healthier food; they experience less stress; they work in jobs that allow them sick days to heal; they can take vacations; and they have better access to healthcare. People who are in a lower SES group can’t afford much of anything.

Headache doctors have done some interesting research on the relationship between SES and the incidence of migraine that can help us think through how the recession might be affecting migraine. This research has consistently found that people who have lower incomes are more likely to have migraines than people with higher incomes.1 But they may not know that they have a migraine, since paradoxically, it’s people with higher incomes who are more likely to receive a diagnosis of migraine. (That’s the benefit of being able and willing to see a good doctor!)2

The puzzle, here, is to figure out why SES is linked to the incidence of migraine. It’s interesting to note that, so far, this relationship has not been found in countries outside the US. (Although there haven’t been many studies of this sort.)

There are a couple of different ways that the two variables could be linked. It could be that people with migraine miss education and occupation opportunities, so their income goes down. Or the causal relationship could go in the opposite direction: it may be that factors linked to low SES, like stress, poor diet, and limited access to medical care, might bring on migraine. (Of course, there’s a third option — that SES and migraine aren’t related at all and that this relationship is mediated by some unseen third variable.)

Some research suggests that the causal direction depends on whether or not a person has a strong family history of migraine.[3] So for the person who has a parent with migraine, it might not matter that what their socioeconomic circumstances are — they are genetically “programmed” to get migraines. But SES might matter a lot for people who don’t have a strong family history. For this group, living in a poor environment might be enough to induce migraine.

Research on social causation is interesting, especially because — unlike genetics — social factors are something that we can change. More research needs to be done to figure out what it is, exactly, about living in a low SES household that brings on migraines. Is it nutrition? Stress? Lack of exercise? Pinpointing the problem is the first step to developing a solution.

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