Abstract
Objective:
To assess prevalence of migraine or severe headache among US adults by inflammatory bowel disease (IBD) status.
Background:
Emerging evidence in clinical settings suggests a higher prevalence of migraine among patients with IBD than those without IBD.
Methods:
Data from 60,436 US adults aged ≥18 years participating in the 2015 and 2016 National Health Interview Survey (NHIS) were analyzed. The relationship between IBD status and migraine or severe headache were assessed overall and stratified by levels of selected characteristics including sex, age, race/ethnicity, education, poverty status, marital status, smoking status, obesity status, serious psychological distress, and major chronic condition status.
Results:
Overall, the age-adjusted prevalence of migraine or severe headache was 15.4% (n=9,062) and of IBD was 1.2% (n=862). A higher age-adjusted migraine or severe headache prevalence was reported among participants with IBD than those without IBD (28.1% vs. 15.2%, p<0.0001). The association of migraine or severe headache with IBD remained significant overall [adjusted prevalence ratio (95% CI)=1.59 (1.35–1.86)] and within the levels of most other selected characteristics after controlling for all other covariates.
Conclusions:
Our results confirmed a higher prevalence of migraine or severe headache among US adults with IBD than those without. Healthcare providers might assess migraine or severe headache among patients with IBD to improve management and quality of life.
Keywords: headache, migraine, inflammatory bowel disease, population study
Introduction
Migraine, a recurrent primary headache disorder that in 2018 affected 15.9% of US adults aged ≥18 years in the previous 3-month period, is one of the most common disability conditions.1,2 The International Classification of Headache Disorders-3rd Edition can be used for the diagnosis of migraine.3 Migraine disproportionally affects women (21.0.% for women vs. 10.7% for men)1 and is more likely to occur among young adults (20.1% for those aged 30–39 years vs. 4.0% for those aged ≥70 years).4 Furthermore, migraine is often comorbid with other chronic conditions including depression or anxiety, asthma, heart disease, stroke, insomnia, and some gastrointestinal diseases such as irritable bowel syndrome and celiac disease.5–9 Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is characterized by chronic inflammation of the gastrointestinal tract and affected about 3.1 million (1.3%) US adults in 2015.10 Diagnosis of Crohn’s disease or ulcerative colitis is usually determined based on the findings of a comprehensive physical examination, laboratory test, imaging, and endoscopy.11,12 IBD is a lifetime systemic disorder that may demonstrate similar aforementioned epidemiological characteristics of migraine or severe headache such as being more likely to be first diagnosed among children or young adults and more likely to co-occur with other chronic conditions including asthma, depression or anxiety, headache, and other neurological disorders.13–17 To date, the association of migraine with IBD has been reported only in clinically-based research with small samples.18–21 A Swiss study using a large insurance claims dataset also observed an association of migraine with IBD22 but did not report association with sociodemographic characteristics and risk factors. In this study, we used US national survey data to assess the hypothesis that adults with IBD would have a higher prevalence of migraine or severe headache than those without IBD.
Methods
The National Health Interview Survey (NHIS) is a cross-sectional household survey that provides nationally representative estimates of self-reported health information for the civilian, noninstitutionalized US population. The IBD question was included in the 2015 and 2016 NHIS Sample Adult Core. To gain more statistical power for comparisons among subgroups, data from both 2015 and 2016 were combined. Detailed information about the study design and questionnaire related to sample adults is available.23,24 The final response rate was 55.2% in 2015 and 54.3% in 2016.23,24
Measures
Outcome and exposure variables
Migraine or severe headache was defined by an affirmative response to the question “During the past 3 months, did you have migraine or severe headache?” The interviewees were asked to report pain that last a whole day or more rather than fleeting or minor pain.23,24 IBD was defined by an affirmative response to the question about having been told by a health professional that one had Crohn’s disease or ulcerative colitis. Previous research indicated that self-reported physician-diagnosed IBD and migraine or severe headache were feasible and reliable measures in a large population-based study.25,26
Covariates
Sociodemographic characteristics included in this study were sex, age group (18–44, 45–64, and ≥65 years), race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and non-Hispanic other), education level (less than high school, high school diploma or general equivalency diploma (GED), some college or technical school, and college graduate), marital status (married or member of unmarried couple, divorced/separated/widowed, and never married), and federal poverty status (<100% federal poverty level (FPL), 100%–<200% FPL, 200%–<399% FPL, and ≥400 FPL, which was calculated using NHIS imputed income files at [https://www.cdc.gov/nchs/data/nhis/tecdoc16.pdf]). Smoking status was defined by two questions “Have you smoked at least 100 cigarettes in your entire life?” and “Do you currently smoke every day, some days, or not at all?” Participants were categorized as current smokers (smoked at least 100 cigarettes during their lifetime and currently smoked every day or some days), former smokers (smoked at least 100 cigarettes during their lifetime but did not currently smoke), and never smokers (never smoked at least 100 cigarettes during their lifetime). Body mass index (BMI, kg/m2), calculated from self-reported height and weight, was categorized as non-obese (BMI<30.0) and obese (BMI≥30.0).
An indicator for chronic conditions was created and defined as “yes” when a respondent had an affirmative response to any of six major chronic conditions: 1) heart disease including coronary heart disease, angina pectoris, heart attack or a heart condition/disease; 2) stroke; 3) arthritis; 4) asthma ever; 5) cancer; and 6) chronic obstructive pulmonary disease (COPD) including emphysema, chronic bronchitis, or COPD. Serious psychological distress was based on responses to six core questions; “During the past 30 days, how often did you feel 1) So sad that nothing could cheer you up?; 2) Nervous?; 3) Restless or fidgety?; 4) Hopeless?; 5) That everything was an effort?; 6) Worthless?” The responses were recorded on a Likert scale (0=“none of the time”; 1=“a little of the time”; 2=“some of the time”; 3=“most of the time”; 4=“all of the time”) and summed (range 0–24). Serious psychological distress, which is a proxy for mental health status, was defined if the summed scale ≥13.27
Statistical Analysis
No differences were found when comparing the distribution of NHIS data including IBD and migraine or severe headache between 2015 and 2016. The 2015 and 2016 data sets were combined resulting in a total of sample of 60,436 adults with complete information after 571 pregnant women and 5,693 observations with missing values were excluded (1,199 on age, 260 on education, 135 on marital status, 242 on smoking status, 2,276 on obesity status, 2,251 on serious psychological distress, 22 on any of six major chronic conditions, 90 on IBD status, and 44 on migraine or severe headache). Prevalence of migraine or severe headache and 95% confidence intervals (CIs) and by selected characteristics were calculated. The estimates were age-standardized to the 2000 projected US population aged ≥18 years (using the age distribution #8: 18–24, 25–44, 45–64, ≥65 years).28 Multivariable logistic regression analyses were performed to assess the association between IBD status and migraine or severe headache overall and stratified by levels of selected characteristics in the subgroup analyses, after controlling for sex, age group, race/ethnicity, education, employment status, marital status, poverty status, smoking status, obesity status, and having any of the aforementioned chronic conditions. Appropriate analytic methods were applied to take sampling weights and the complex sampling design into account (#2 method).29 Unreliable estimates are not presented if the relative standard error was >0.3. All analyses were performed using SAS (SAS International Institute, version 9.3) and SAS-callable SUDAAN (Research Triangle Institute, version 11.0.3). Statistical significance for comparisons was tested using a two-sided t-test at p<0.05.
Results
There were 862 adults (1.2%) who reported having IBD in the combined 2015 and 2016 NHIS. Compared to participants without IBD, those with IBD were more likely to be women; middle-aged or older adults (aged ≥45 years); non-Hispanic white; widowed, divorced, or separated; former smokers; to have reported serious psychological distress; to have reported any chronic condition; and to have reported migraine or severe headache (Table 1).
Table 1.
Distribution of selected characteristics among 60,436 adults aged ≥18 years, by IBD status*, United States, 2015–2016 National Health Interview Survey
| IBD (n=862) | No IBD (n=59,574) | |||
|---|---|---|---|---|
| Characteristic | n† | % (95% CI)¶ | n† | % (95% CI)¶ |
| Sex | ||||
| Men | 315 | 40.7 (36.5–45.1) | 27,675 | 49.7 (49.2–50.3) |
| Women | 547 | 59.3 (54.9–63.5) | 31,899 | 50.3 (49.7–50.8) |
| Age group (year) | ||||
| 18–44 | 230 | 30.4 (26.5–34.6) | 24,529 | 47.3 (46.7–48.0) |
| 45–64 | 356 | 43.3 (39.0–47.7) | 19,313 | 33.0 (32.4–33.5) |
| ≥65 | 276 | 26.3 (22.7–30.3) | 15,732 | 19.7 (19.2–20.2) |
| Race/ethnicity | ||||
| Non-Hispanic white | 677 | 75.6 (71.1–79.7) | 39,271 | 64.5 (63.5–65.4) |
| Non-Hispanic black or African American | 53 | 5.3 (3.7– 7.4) | 7,038 | 11.6 (11.1–12.2) |
| Hispanic | 91 | 14.3 (10.7–18.9) | 8,436 | 15.9 (15.1–16.7) |
| Non-Hispanic other | 41 | ~ | 4,829 | 8.0 (7.6– 8.4) |
| Educational level | ||||
| High school or less | 94 | 12.6 (9.2–17.1) | 6,373 | 10.2 (9.8–10.6) |
| High school graduate or GED | 231 | 27.0 (23.3–31.1) | 16,047 | 26.9 (26.3–27.5) |
| Some college | 278 | 30.6 (26.7–34.7) | 18,782 | 31.2 (30.6–31.8) |
| College graduate | 259 | 29.8 (25.9–33.9) | 18,372 | 31.8 (31.0–32.5) |
| Marital status | ||||
| Married | 398 | 59.2 (54.7–63.6) | 29,923 | 60.4 (59.8–61.1) |
| Widowed, divorced, separated | 305 | 25.6 (22.0–29.6) | 15,863 | 16.9 (16.6–17.3) |
| Never married | 159 | 15.1 (12.2–18.6) | 13,788 | 22.6 (22.1–23.2) |
| Federal poverty status** | ||||
| <100% FPL | 148 | 14.1 (11.3–17.4) | 9,093 | 12.4 (11.9–12.8) |
| 100–199% FPL | 177 | 17.3 (14.0–21.0) | 11,654 | 17.9 (17.4–18.4) |
| 200–399% FPL | 234 | 28.3 (24.2–32.8) | 17,336 | 29.1 (28.5–29.6) |
| ≥400% FPL | 303 | 40.3 (35.8–45.0) | 21,491 | 40.6 (39.8–41.4) |
| Smoking status | ||||
| Current smoker | 167 | 17.8 (14.7–21.3) | 9,676 | 15.3 (14.9–15.8) |
| Former smoker | 275 | 30.4 (26.3–34.8) | 14,231 | 21.9 (21.5–22.4) |
| Non-smoker | 420 | 51.9 (47.5–56.2) | 35,667 | 62.8 (62.1–63.4) |
| Body mass index (BMI, kg/m2) | ||||
| Non-obese (BMI<30.0) | 585 | 69.2 (64.8–73.2) | 41,462 | 70.1 (69.6–70.7) |
| Obese (BMI≥30.0) | 277 | 30.8 (26.8–35.2) | 18,112 | 29.9 (29.3–30.4) |
| Serious psychological distress¶¶ | ||||
| Yes | 593 | 65.6 (60.8–70.0) | 27,450 | 42.0 (41.4–42.6) |
| No | 269 | 34.4 (30.0–39.2) | 32,124 | 58.0 (57.4–58.6) |
| Any of 6 major chronic conditions‡ | ||||
| Yes | 78 | 8.1 (5.7–11.3) | 2,215 | 3.5 (3.2– 3.7) |
| No | 784 | 91.9 (88.7–94.3) | 57,359 | 96.5 (96.3–96.8) |
| Migraine or severe headache~~ | ||||
| Yes | 226 | 27.2 (23.1–31.7) | 8,836 | 14.8 (14.4–15.2) |
| No | 636 | 72.8 (68.3–76.9) | 50,738 | 85.2 (84.8–85.6) |
Inflammatory bowel disease (IBD) was defined based on the response to the question “Have you ever been told by a doctor or other health professional that you had Crohn’s disease or ulcerative colitis?”
Unweighted sample size.
Weighted percentage and 95% confidence interval (CI).
Unreliable estimates if the relative standard error>0.3.
Federal poverty level (FPL) was defined based on 2017 HHS guidelines at https://aspe.hhs.gov/2017-poverty-guidelines.
Serious psychological distress was based on responses to six questions: “During the past 30 days, how often did you feel 1) Feeling so sad that nothing could cheer you up?; 2) Nervous?; 3) Restless or fidgety?; 4) Hopeless?; 5) That everything was an effort?; 6) Worthless?” The responses were recorded on a Likert scale (0=“none of the time”; 1=“a little of the time”; 2=“some of the time”; 3=“most of the time”; 4=“all of the time”) and summed (range 0–24). Serious psychological distress, which is a proxy for mental health status, was defined if the summed scale ≥13.
Any of 6 major chronic conditions was defined as “Yes” if the respondent reported being told by a doctor or other health professional that they had any of the following conditions: 1) coronary heart disease, or angina pectoris, or a heart attack, or a heart condition/disease; 2) stroke; 3) arthritis; 4) asthma ever; 5) cancer;6) chronic obstructive pulmonary disease (COPD) including emphysema, or chronic bronchitis, or COPD.
Migraine or severe headache was defined based on the response to the question “During the past 3 months, did you have severe headache or migraine?”
The overall age-adjusted prevalence of migraine or severe headache was 15.4% (n=9,062) and of IBD was 1.2% (n=862). Participants with IBD reported a higher age-adjusted prevalence of migraine or severe headache than those without IBD [(28.1% vs. 15.2%, p<0.0001, Table 2]. The association of migraine or severe headache with IBD remained significant overall [adjusted prevalence ratio (PR) (95% CI)=1.59 (1.35–1.86)] and within most levels of other selected characteristics after controlling for all covariates (except for those who were aged ≥65 years, had a high school diploma or GED, or 4-year college degree or above, and with poverty level ≥200% FPL). For example, a higher prevalence of migraine or severe headache was observed among both men [adjusted PR (95% CI)=1.68 (1.20–2.35)] and women [adjusted PR (95% CI)=1.54 (1.30–1.82)] with IBD than their counterparts without IBD after controlling for all covariates. In addition, a high prevalence of migraine or severe headache (>40%) was observed among adults with IBD who had less than a high school education, poverty level <100% FPL, were current smokers, obese, and with serious psychological distress.
Table 2.
Age-adjusted prevalence* and adjusted prevalence ratio† of migraine or severe headache among 60,436 US participants aged ≥18 years, by IBD status¶, United States, 2015–2016 National Health Interview Survey
| Age-adjusted prevalence of migraine or severe headache, % (95% CI)* | Adjusted prevalence ratio† (95% CI) | ||
|---|---|---|---|
| Characteristic | IBD (n=862) | No IBD (n=59,574) | |
| Crude prevalence | 27.2 (23.1–31.7) | 14.8 (14.4–15.2) | |
| Age-adjusted prevalence | 28.1 (23.5–33.1) | 15.2 (14.8–15.7) | 1.59 (1.35–1.86) |
| Sex | |||
| Men | 20.8 (14.7–28.6) | 10.0 (9.5–10.5) | 1.68 (1.20–2.35) |
| Women | 33.2 (27.5–39.5) | 20.6 (19.9–21.3) | 1.54 (1.30–1.82) |
| Age group (year) | |||
| 18–44 | 29.8 (21.9–39.0) | 17.9 (17.1–18.7) | 1.30 (1.00–1.68) |
| 45–64 | 37.5 (29.7–46.0) | 16.6 (15.9–17.4) | 1.89 (1.52–2.34) |
| ≥65 | 16.0 (11.9–21.3) | 8.3 (7.8– 8.8) | 1.31 (0.84–2.05) |
| Race/ethnicity | |||
| Non-Hispanic whites | 26.8 (21.8–32.6) | 15.9 (15.3–16.5) | 1.42 (1.21–1.67) |
| Non-Hispanic black or African American | -** | 15.2 (14.1–16.5) | -** |
| Hispanic | 38.6 (26.2–52.6) | 14.6 (13.7–15.6) | 2.31 (1.52–3.52) |
| Non-Hispanic others | -** | 13.1 (12.0–14.4) | -** |
| Educational level | |||
| High school or less | 48.7 (34.8–62.9) | 19.0 (17.6–20.5) | 2.32 (1.58–3.42) |
| High school graduate or GED | 24.2 (16.8–33.5) | 15.6 (14.8–16.4) | 1.29 (0.92–1.81) |
| Some college | 34.9 (27.0–43.8) | 16.7 (16.0–17.5) | 1.76 (1.41–2.20) |
| College graduate | 13.6 (9.3–19.5) | 12.5 (11.8–13.3) | 1.17 (0.82–1.66) |
| Marital status | |||
| Married | 26.6 (19.2–35.6) | 15.4 (14.8–16.1) | 1.48 (1.20–1.83) |
| Widowed, divorced, separated | 31.3 (21.8–42.8) | 18.5 (16.6–20.5) | 1.76 (1.34–2.32) |
| Never married | 28.1 (20.2–37.8) | 15.4 (14.5–16.3) | 1.59 (1.15–2.22) |
| Federal poverty statusǂ | |||
| <100% FPL | 53.1 (42.3–63.7) | 21.5 (20.3–22.8) | 2.09 (1.66–2.63) |
| 100–199% FPL | 38.6 (27.0–51.6) | 19.6 (18.6–20.7) | 1.66 (1.22–2.24) |
| 200–399% FPL | 26.4 (18.2–36.8) | 14.9 (14.2–15.7) | 1.36 (0.94–1.97) |
| ≥400% FPL | 16.5 (10.4–25.0) | 11.9 (11.2–12.7) | 1.41 (0.99–2.01) |
| Smoking status | |||
| Current smoker | 41.8 (30.8–53.6) | 21.2 (20.1–22.3) | 1.52 (1.21–1.91) |
| Former smoker | 26.6 (18.5–36.5) | 15.9 (14.8–17.2) | 1.66 (1.23–2.24) |
| Non-smoker | 24.4 (18.5–31.5) | 13.7 (13.2–14.2) | 1.58 (1.22–2.06) |
| Body mass index (BMI, kg/m2) | |||
| Non-obese (BMI<30.0) | 22.8 (17.8–28.7) | 14.0 (13.5–14.6) | 1.40 (1.11–1.78) |
| Obese (BMI≥30.0) | 40.4 (31.1–50.4) | 18.2 (17.3–19.1) | 1.90 (1.53–2.36) |
| Serious psychological distress¶¶ | |||
| Yes | 71.4 (54.7–83.8) | 45.9 (42.8–49.1) | 1.75 (1.48–2.07) |
| No | 24.3 (20.0–29.2) | 14.1 (13.7–14.5) | 1.49 (1.25–1.77) |
| Any of 6 major chronic conditions*** | |||
| Yes | 38.6 (31.3–46.5) | 22.9 (22.0–23.8) | 1.56 (1.34–1.81) |
| No | 18.1 (11.9–26.6) | 11.2 (10.7–11.7) | 1.55 (1.01–2.37) |
Age-adjusted prevalence (except for age groups and crude total) was standardized to the 2000 projected US population aged ≥18 years (using age groups 18–24, 25–44, 45–64, ≥65 years).
Adjusted prevalence ratio (prevalence in IBD/prevalence in non-IBD) and 95% confidence ratio (CI) were derived from a multivariable logistic regression model that include sex, age group, race/ethnicity, education, poverty status, marital status, smoking status, obesity status, serious psychological distress, and major chronic condition status.
Inflammatory bowel disease (IBD) was defined based on the response to the question “Have you ever been told by a doctor or other health professional that you had Crohn’s disease or ulcerative colitis?”
Unreliable estimates if the relative standard error>0.3.
Federal poverty level (FPL) was defined based on 2017 HHS guidelines at https://aspe.hhs.gov/2017-poverty-guidelines.
Serious psychological distress was based on responses to six questions: “During the past 30 days, how often did you feel 1) Feeling so sad that nothing could cheer you up?; 2) Nervous?; 3) Restless or fidgety?; 4) Hopeless?; 5) That everything was an effort?; 6) Worthless?” The responses were recorded on a Likert scale (0=“none of the time”; 1=“a little of the time”; 2=“some of the time”; 3=“most of the time”; 4=“all of the time”) and summed (range 0–24). Serious psychological distress, which is a proxy mental health status, was defined if the summed scale ≥13.
Any of 6 major chronic conditions was defined as “Yes” if the respondent reported being told by a doctor or other health professional that they had any of the following conditions: 1) coronary heart disease, or angina pectoris, or a heart attack, or a heart condition /disease; 2) stroke; 3) arthritis; 4) asthma ever; 5) cancer; 6) chronic obstructive pulmonary disease (COPD) including emphysema, or chronic bronchitis, or COPD.
Previous studies indicated that chronic pain was also a common symptom in adults with IBD.30 To distinguish the association of IBD with migraine or severe headache from chronic pain in general, we conducted a post hoc sensitivity analysis by excluding those who reported having chronic pain in 2016 (a chronic pain question was available in the 2016 but not in the 2015 NHIS). Chronic pain was defined as a response of ‘most days’ or ‘every day’ to the question “In the past 6 months, how often did you have pain?” In this analysis, the prevalence of migraine or severe headache in 2016 remained significantly higher among the respondents with IBD than those without IBD [age-adjusted prevalence (95% CI): 20.7% (13.1–31.1) vs. 11.1% (10.6–11.7)].
Discussion
Our results from a US national survey confirmed a higher prevalence of migraine or severe headache among adults with IBD than their counterparts without IBD in the general population after adjustment for covariates such as age, poverty status, health-risk behaviors, serious psychological distress, and some major chronic conditions. The magnitude of the association between IBD and migraine was consistent with results from prior studies in clinical settings18,19,21. To the best of our knowledge, this is the first report to demonstrate an association between self-reported physician-diagnosed IBD and recent severe headache or migraine in a nationally representative sample of US civilian, non-institutionalized adults.
The mechanism between migraine and IBD is not fully understood. Evidence indicates that IBD and migraine or severe headache might be linked through a complex gut-brain interaction.31 Our findings, which add insights into a growing body of research, show that migraine or severe headache is not only more prevalent in women than in men, but also is associated with lower socioeconomic status, smoking, obesity, serious psychological distress, and greater comorbidities among adults with IBD.18,19,21 Although IBD currently cannot be prevented, our results indicate that screening for migraine or severe headache among patients with IBD, especially among the high-risk population, may be important. In addition, adequate pharmacological and nutritional therapy might reduce migraine or severe headache among adults with IBD and improve quality of life.32,33
The strength of this study is that our results were based on a large national population survey. However, our findings are subject to the following limitations. First, both migraine and IBD were ascertained by single questions, which were not confirmed by medical records. The NHIS question does not differentiate migraine from severe headache, nor does it ascertain subtype of migraine. Further, we were unable to distinguish primary migraine/severe headache from secondary causes.34 Nonetheless, our results among a large national survey align with results from clinical populations and add to the growing evidence of an association between migraine and IBD. Further, our sensitivity analysis, using 2016 data only suggested that associations remained when excluding adults who reported chronic pain in general. In addition, the NHIS question does not differentiate subtypes of migraine or migraine from other types of severe headache. The NHIS migraine question also only captures the information of adult respondents who had migraine or a severe headache three month prior to the interview. Therefore, the prevalence of migraine in this study could be underestimated. Further studies on migraine may distinguish Crohn’s disease and ulcerative colitis to assess different disease mechanisms and epidemiological characteristics. Second, the survey does not include a measure about frequency or intensity of migraine. Therefore, we were unable to differentiate chronic migraine from episodic migraine. Third, self-reported variables are subject to recall bias. Fourth, we were unable to assess association of other risk factors associated with migraine that were not ascertained in the survey, such as sleep apnea and anemia.8,35 However, several major common chronic conditions were included in our analyses so that the variations derived from less common conditions may not be so great as to substantially attenuate the observed associations. Finally, our results cannot be applied to active duty military personnel, or institutionalized adults who are living in long-term care facilities or prisons.
In conclusion, our results from a US national survey confirmed a higher prevalence of migraine or severe headache among adults with IBD than those without. Healthcare providers might assess migraine among IBD patients who may benefit from the treatment and prevention of migraine or severe headache.
Acknowledgements/Disclaimer:
We are very grateful for the valuable edits on the manuscript made by Mr. Michael Weeks from the Office of Director at CDC/NCCDPHP and Dr. Anjel Uahratian from CDC/NCHS/DHIS. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Abbreviations:
- IBD
inflammatory bowel disease
- NHIS
National Health Interview Survey
- CI
confidence interval
- FPL
federal poverty level
- BMI
body mass index
- COPD
chronic obstructive pulmonary disease
Footnotes
Conflicts of Interest: All authors have no conflict of interest to declare.
References
- 1.Villarroel MA, Blackwell DL, Jen A. Tables of summary health statistics for U.S. adults: 2018 National Health Interview Survey. National Center for Health Statistics;2018. [Google Scholar]
- 2.Steiner TJ, Stovner LJ, Vos T. GBD 2015: migraine is the third cause of disability in under 50s. J Headache Pain. 2016; 17: 104–107. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Olesen J, Bendtsen L, Dodick D, et al. The International Classification of Headache Disorders: 3rd edition. Cephalalgia. 2018; 38 (1): 1–211. [DOI] [PubMed] [Google Scholar]
- 4.Bigal ME, Liberman JN, Lipton RB. Age-dependent prevalence and clinical features of migraine. Neurol. 2006; 67 (2): 246–251. [DOI] [PubMed] [Google Scholar]
- 5.Breslau N, Lipton RB, Stewart WF, Schultz LR, Welch KM. Comorbidity of migraine and depression: investigating potential etiology and prognosis. Neurol. 2003; 60 (8): 1308–1312. [DOI] [PubMed] [Google Scholar]
- 6.Gabrielli M, Cremonini F, Fiore G, et al. Association between migraine and celiac disease: results from a preliminary case-control and therapeutic study. Am J Gastroenterol. 2003; 98 (3): 625–629. [DOI] [PubMed] [Google Scholar]
- 7.Buring JE, Hebert P, Romero J, et al. Migraine and subsequent risk of stroke in the Physicians’ Health Study. Arch Neurol. 1995; 52 (2): 129–134. [DOI] [PubMed] [Google Scholar]
- 8.Scher AI, Bigal ME, Lipton RB. Comorbidity of migraine. Curr Opin Neurol. 2005; 18 (3): 305–310. [DOI] [PubMed] [Google Scholar]
- 9.Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ. 1992; 304 (6819): 87–90. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Dahlhamer JM, Zammitti EP, Ward BW, Wheaton AG, Croft JB. Prevalence of inflammatory bowel disease among adults aged ≥18 years - United States, 2015. MMWR Morb Mortal Wkly Rep. 2016; 65 (42): 1166–1169. [DOI] [PubMed] [Google Scholar]
- 11.Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG Clinical Guideline: Management of Crohn’s Disease in Adults. Am J Gastroenterol. 2018; 113 (4): 481–517. [DOI] [PubMed] [Google Scholar]
- 12.Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG Clinical Guideline: Ulcerative Colitis in Adults. Am J Gastroenterol. 2019; 114 (3): 384–413. [DOI] [PubMed] [Google Scholar]
- 13.Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel disease. Gastroenterol. 2011; 140: 1785–1794. [DOI] [PubMed] [Google Scholar]
- 14.Mikocka-Walus A, Knowles SR, Keefer L, Graff L. Controversies revisited: A systematic review of the comorbidity of depression and anxiety with inflammatory bowel diseases. Inflamm Bowel Dis. 2016; 22: 752–762. [DOI] [PubMed] [Google Scholar]
- 15.Bernstein CN, Wajda A, Blanchard JF. The clustering of other chronic inflammatory diseases in inflammatory bowel disease: a population-based study. Gastroenterol. 2005; 129 (3): 827–836. [DOI] [PubMed] [Google Scholar]
- 16.Ben-Or O, Zelnik N, Shaoul R, Pacht A, Lerner A. The neurologic profile of children and adolescents with inflammatory bowel disease. J Child Neurol. 2015; 30 (5): 551–557. [DOI] [PubMed] [Google Scholar]
- 17.Oliveira GR, Teles BC, Brasil EF, et al. Peripheral neuropathy and neurological disorders in an unselected Brazilian population-based cohort of IBD patients. Inflamm Bowel Dis. 2008; 14 (3): 389–395. [DOI] [PubMed] [Google Scholar]
- 18.Cheraghi SC, Daryani N,E,, Ghabaee M. A survey on migraine prevalence in patients with inflammatory bowel disease - A single centre experience. Middle East J Dig Dis. 2016; 8: 282–288. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Dimitrova AK, Ungaro RC, Lebwohl B, et al. Prevalence of migraine in patients with celiac disease and inflammatory bowel disease. Headache. 2013; 53 (2): 344–355. [DOI] [PubMed] [Google Scholar]
- 20.Ford S, Finkel AG, Issac KL. Migraine in patients with inflammatory bowel disorders. J Clin Gastroenterol. 2009; 43 (5): 499. [DOI] [PubMed] [Google Scholar]
- 21.Moisset X, Bommelaer G, Boube M, et al. Migraine prevalence in inflammatory bowel disease patients: A tertiary-care centre cross-sectional study. Eur J Pain. 2017; 21 (9): 1550–1560. [DOI] [PubMed] [Google Scholar]
- 22.Bahler C, Schoepfer AM, Vavricka SR, Brungger B, Reich O. Chronic comorbidities associated with inflammatory bowel disease: prevalence and impact on healthcare costs in Switzerland. Eur J Gastroenterol Hepatol. 2017; 29 (8): 916–925. [DOI] [PubMed] [Google Scholar]
- 23.National Center for Health Statistics. Survey description, National Health Interview Survey, 2015. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2015/srvydesc.pdf2016.
- 24.National Center for Health Statistics. Survey description, National Health Interview Survey, 2016. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2016/srvydesc.pdf2017.
- 25.Kelstrup AM, Juillerat P, Korzenik J. The accuracy of self-reported medical history: a preliminary analysis of the promise of internet-based research in Inflammatory Bowel Diseases. J Crohns Colitis. 2014; 8 (5): 349–356. [DOI] [PubMed] [Google Scholar]
- 26.Schurks M, Buring JE, Kurth T. Agreement of self-reported migraine with ICHD-II criteria in the Women’s Health Study. Cephalalgia. 2009; 29 (10): 1086–1090. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003; 60 (2): 184–189. [DOI] [PubMed] [Google Scholar]
- 28.Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People 2000 Stat Notes. 2001; (20): 1–9. [PubMed] [Google Scholar]
- 29.National Center for Health Statistics. Variance Estimation Guidance, NHIS 2016–2017 (Adapted from NHIS Survey Description Documents), October, 2018. https://www.cdc.gov/nchs/data/nhis/2016var.pdf.
- 30.Morrison G, Van Langenberg DR, Gibson SJ, Gibson PR. Chronic pain in inflammatory bowel disease: characteristics and associations of a hospital-based cohort. Inflamm Bowel Dis. 2013; 19 (6): 1210–1217. [DOI] [PubMed] [Google Scholar]
- 31.Drossman DA, Hasler WL. Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology. 2016; 150 (6): 1257–1261. [DOI] [PubMed] [Google Scholar]
- 32.Arzani M, Jahromi SR, Ghorbani Z, et al. Gut-brain Axis and migraine headache: a comprehensive review. J Headache Pain. 2020; 21 (1): 15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Jahromi SR,, Ghorbani Z, Martelletti P, Lampl C, Togha M. Association of diet and headache. The journal of Headache and Pain. 2019; 10: 106–116. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Ashina M, Hansen JM, Do TP, Melo-Carrillo A, Burstein R, Moskowitz MA. Migraine and the trigeminovascular system-40 years and counting. Lancet Neurol. 2019; 18 (8): 795–804. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Kristiansen HA, Kvaerner KJ, Akre H, Overland B, Russell MB. Migraine and sleep apnea in the general population. J Headache Pain. 2011; 12 (1): 55–61. [DOI] [PMC free article] [PubMed] [Google Scholar]