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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
-1 Lipton, R. B., W. F. Stewart, et al. (2001). “Prevalence and Burden of Migraine in the United States: Data from the American Migraine Study II.” Headache 41: 646-657. | 2- Lipton, R. B., S. Diamond, et al. (2001). “Migraine Diagnosis and Treatment: Results from the American Migraine Study II.” Headache 41: 638-645. – [3] Bigal, M. E., R. B. Lipton, et al. (2007). “Migraine in Adolescents: Association with Socioeconomic Status and Family History.” Neurology 69: 16-25.

Comments

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  • Betsy Blondin
    7 years ago

    Hi, Joanna!

    This post concerns me deeply and I wanted to ask you to clarify. (Please also see my comments on your next post about whether migraine is a disease or a condition.)

    I appreciate the efforts, research and time you are devoting to migraine and the discussion of migraine terms as well as the questions you raise above.

    Are you saying here that migraine can be CAUSED by SES, nutrition, stress, lack of exercise or other social factors, or do you feel migraine is a disorder or disease wherein attacks can be TRIGGERED by socioeconomic factors?

    Thank you,
    Betsy

  • Joanna Kempner
    7 years ago

    Hi Betsy,

    This is an important question! I’m sorry that I’ve only now just seen it. First, I should say that my language of “causation” in this blog post is taken directly from the articles that it cites — written by top headache specialists who are also epidemiologists. So I’m not out on a limb here. This research is particularly interesting because it demonstrated that low SES was associated with a higher prevalence of migraine even in the absence of a family history, suggesting that there is something funky going on with how we typically think about “causation.”

    I know that this is a hot-button topic and I understand why. Nobody wants to go back to the days when individuals were blamed for having their migraines. At the same time, lots of diseases have social and environmental “causes” that are worth investigating — including cancer, diabetes and asthma. I don’t see why migraine should be different.

    Perhaps we need to complicate what we mean by “cause.” In sociology, we often think in terms of “proximate” and “distal” causes. So, an inherited genetic pathology in the brain might be considered a proximate cause and an environmental trigger might be considered a distal cause. The migraine requires both things to happen.

    Here’s a puzzle: how should we think about recent findings that women who experienced child abuse have much higher rates of migraine? Dr. Gretchen Tietjen has argued that the experience of child abuse may actually change brain chemistry. What causes migraine then? A dysfunctional brain? Or a dysfunctional upbringing? Sometimes cause and effect is muddled.

    Here’s what I think is great news though: social “causes” (or whatever you want to call them) are much more amenable to intervention than biological causes.

    I’ll post about the disease/condition debate under that blog.

    Joanna

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