The Association Between Inflammatory Bowel Disease and Migraine or Severe Headache Among US Adults

Findings From the National Health Interview Survey, 2015-2016

Yong Liu MD; Fang Xu PhD; Anne G. Wheaton PhD; Kurt J. Greenlund PhD; Craig W. Thomas PhD


Headache. 2021;61(4):612-619.. 

In This Article

Abstract and Introduction


Objective: To assess the 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 was 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 = 9062) 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.


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 cause of disability.[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 IBD[22] 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.