Red Blood Cell Distribution Width-to-Albumin Ratio and Migraine: Associations with Prevalence and All-Cause Mortality in a Population-Based Study

Summary

Here, we evaluated the associations of the red blood cell distribution width-to-albumin ratio with migraine prevalence and all-cause mortality among individuals with migraine using data from NHANES 1999–2004. We found that higher RAR levels were significantly associated with an increased likelihood of migraine and higher risk of all-cause mortality among migraine participants.

Abstract

Migraine is a common primary neurovascular disorder associated with substantial morbidity and systemic inflammatory alterations. The red blood cell distribution width-to-albumin ratio (RDW-to-albumin ratio, RAR) is an emerging marker of systemic inflammation and nutritional status; however, standardized approaches for evaluating its association with migraine outcomes in large population datasets are limited. Using data from the National Health and Nutrition Examination Survey (NHANES) 1999–2004, this study evaluated the relationship between RAR and migraine prevalence, as well as all-cause mortality among individuals with migraine. A total of 8,781 participants were included in the cross-sectional analysis, and 1,762 participants with migraine were followed for mortality outcomes. Multivariable logistic and Cox regression models were used to assess the associations. After adjusting for potential confounders, higher RAR levels were significantly associated with an increased likelihood of migraine. Among participants with migraine, elevated RAR was also independently associated with higher all-cause mortality. These findings suggest that RAR may serve as a simple and accessible biomarker for identifying individuals at higher risk of migraine and adverse outcomes, highlighting its potential value in risk stratification and clinical management.

Introduction

Migraine is a prevalent primary neurovascular disorder typically characterized by unilateral pulsatile headache with associated symptoms, such as nausea, vomiting, photophobia, and phonophobia¹. Globally, it ranks among the leading causes of disability and disease burden, adversely affecting the quality of life and socioeconomic productivity². Migraine attacks are recurrent and triggered by multiple factors, and they increase the risk of comorbidities, including cardiovascular disease, anxiety, and depression^3,4. Over time, repeated attacks may induce structural ....

Protocol

The NHANES data-collection protocols were approved by the National Center for Health Statistics (NCHS) Research Ethics Review Board (ERB). As the NHANES datasets are publicly available, researchers do not need additional approval from their own institutional review boards (IRBs).

Study population and eligibility criteria
The NHANES employs a multistage, stratified probability sampling design and collects comprehensive health and nutritional information through household interviews, standardized physical examinations, and laboratory assessments at Mobile Examination Centers (MEC). Publicly available data from the 1999 ....

Results

Cross-sectional study: Baseline characteristics
A total of 8,781 participants were included in the cross-sectional analysis, comprising 7,019 individuals without migraine and 1,762 individuals with migraine. Participants were categorized into quartiles based on their RAR levels. The median age of the overall population was 44 years (IQR: 33–56 years), and age increased progressively across the RAR quartiles from Q1 to Q4. Significant differences in sex, race/ethnicity, education level, marital status.......

Discussion

This nationally representative study based in the U.S. NHANES dataset systematically evaluated the associations of the RAR with the risk of migraine and all-cause mortality. Our findings demonstrated that higher RAR levels were significantly associated with increased migraine risk, even after adjusting for demographic characteristics, lifestyle factors, and clinical comorbidities. Moreover, RAR independently predicted all-cause mortality among patients with migraine, with elevated RAR levels conferring a markedly higher .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
R software, version 4.2.2	R Foundation for Statistical Computing	Not applicable	Statistical analysis and visualization
Coulter automated hematology analyzer	Beckman Coulter	Not applicable	Used for complete blood count (CBC) and other hematology analyses.