Combined Associations of Social Determinants of Health With Self-Reported Severe Headache or Migraine: NHANES 1999–2004

Background: Social determinants of health (SDoH) are increasingly recognized as important contributors to neurological disorders, yet their joint association with migraine remains insufficiently explored. Methods: We analyzed 11,009 adults aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 1999–2004. Self-reported severe headache or migraine was defined based on questionnaire item MPQ090. Multiple social determinants of health (SDoH) indicators were evaluated individually using weighted logistic regression and jointly using weighted quantile sum (WQS) regression in relation to self-reported severe headache or migraine. Results: Several individual social determinants of health (SDoH) indicators were significantly associated with Self-Reported Severe Headache or Migraine. Overall, a higher SDoH burden was associated with increased odds of migraine (OR = 2.26, 95% CI 1.78–2.87, p <0.001), representing the comparison between the highest and lowest quartiles of the WQS index. In the WQS regression, housing status, education level, and family income-to-poverty ratio contributed most to the overall mixture effect. Conclusions: The accumulation of adverse SDoH was positively associated with self-reported severe headache or migraine. Housing conditions, educational attainment, and economic resources contributed most to the observed mixture effect, suggesting that social context may play an important role in migraine burden and prevention.