ArticleHeadache2026
Migraine prevalence and phenotype in autism: A retrospective cohort study using a US National Health Survey and large academic health system electronic health record.
Article in Headache, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveWe analyzed data from both a national survey and a single hospital system to determine the prevalence of migraine in individuals with autism as well as identify sociodemographic and clinical characteristics associated with migraine in individuals with autism.
backgroundFew studies have examined the prevalence of migraine in autism and there are no studies examining the migraine phenotype and clinical features associated with migraine in autism.
methodsThis retrospective cohort study used two databases-the National Survey of Children's Health (NSCH) and the University of California Los Angeles hospital system electronic health record (UCLA EHR). NSCH survey data from 2018, 2019, 2020, and 2021 (data collection period for each year is June to January; e.g., NSCH 2021 period is June 2021 to January 2022; N = 50,892) were queried to identify cohorts based on responses to two survey questions identifying the presence of frequent/severe headache and autism. For UCLA cohorts, patients (12/01/1979-4/16/2023, N = 4,334,162) were queried for migraine and autism based on the International Classification of Diseases diagnosis codes. We tested the hypothesis: Headache/migraine occurs more frequently in individuals with autism versus without autism. Variables including social determinants of health (SDoH) and co-occurring illnesses were compared between autism with versus without headache/migraine.
resultsHeadache and migraine prevalence was higher in individuals with autism versus those without (2021 NSCH-headache % [95% confidence interval {CI}], 7.1% [4.62-9.56] vs. 3.0% [2.62-3.19], p < 0.001 and UCLA-migraine: 3.1% [2.86-3.43] vs. 2.0% [1.97-1.99], p < 0.001). Among those with autism, the presence of headache/migraine was associated with increased odds of adverse childhood experiences such as bullying (NSCH-'Weekly/Almost daily' bullying aOR = 5.93 [2.01-17.50], p = 0.001, 'Never' reference) and being a victim of violence (NSCH-'Yes' aOR = 2.82, [1.19-6.66], p = 0.018), poor general health (NSCH-'Fair/Poor' health aOR = 9.68, [3.01-31.19], p < 0.001, 'Excellent' reference), mood disturbances, including anxiety (NSCH-'Yes' aOR = 4.50, [1.63-12.41], p = 0.004; UCLA aOR = 3.40, [2.78-4.17], p < 0.001), and depression (NSCH-'Yes' aOR = 5.70, [2.50-12.97], p < 0.001; UCLA aOR = 3.76, [3.08-4.60], p < 0.001), as well as increased rates of concussion (NSCH-'Yes' aOR = 9.05, [3.19-25.66], p < 0.001; UCLA aOR = 10.28, [6.91-15.30], p < 0.001).
conclusionsHeadache/migraine occurs at higher rates in individuals with autism and is associated with increased odds of negative SDoH and clinically relevant co-occurring illnesses. This study highlights the importance of migraine screening in individuals with autism. Future work is needed to understand the burden and impact of migraine in autism.
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