T H E J O U R N A L O F H U M A N R E S O U R C E S • 46 • 2
The Effect of Migraine Headache on Educational Attainment
Daniel I. Rees Joseph J. Sabia
A B S T R A C T
Despite the fact that migraine headaches are common and debilitating, lit- tle is known about their effect on educational attainment. Using data
drawn from the National Longitudinal Study of Adolescent Health, we esti- mate the relationship between migraine headache and three outcomes:
high school grade point average, the probability of graduating high school, and the probability of attending college. Our results provide evidence that
migraine headache negatively impacts human capital accumulation. The relationship between migraine headache and educational attainment is ex-
plained, in part, through its effect on school absences and the respondent’s self-reported ability to pay attention in class and complete homework.
“Only if you’ve had a severe migraine can you appreciate how dev- astating this is to the life and composure of the victim.”
Dr. Seymour Diamond, Executive Chairman of the National Headache Foundation
I. Introduction
The International Headache Society IHS classifies headaches as either primary or secondary. While secondary headaches can be caused by, for in-
Daniel Rees is a professor of economics at the University of Colorado Denver. Joseph Sabia is an assis- tant professor of economics at the United States Military Academy. They thank Hani Mansour, seminar
participants at the Federal Reserve Bank of Atlanta, George Washington University, and the University of Oregon, and an anonymous referee for helpful comments. The views expressed herein are those of the
authors and do not reflect the position of the United States Military Academy, the Department of the Army, or the Department of Defense. The data used are from The National Longitudinal Study of Ado-
lescent Health, conducted by J. Richard Udry of the Carolina Population Center, CB 8120, University Square, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516–3997. Funding for the
data collection was provided by the National Institute of Child Health and Human Development NICHD under Grant No. P01-HD31921. The data used to conduct this study may be obtained from this source.
[Submitted July 2009; accepted April 2010] ISSN 022-166X E-ISSN 1548-8004 䉷 2011 by the Board of Regents of the University of Wisconsin System
318 The Journal of Human Resources
stance, trauma to the head, a sinus infection, or a night on the town, primary head- aches are by definition not the result of a treatable medical condition or pathology
Gladstein 2006. There are three types of primary headache. Tension headache is the most common,
affecting anywhere between 30 to 80 percent of the North AmericanWestern Eu- ropean population Kaniecki 2002. Migraine headache is the second most common,
affecting between 10 and 12 percent of the population Breslau and Rasmussen 2001. Cluster headache is the rarest but most severe type of primary headache. It
affects approximately one out of 500 individuals of European decent Russell 2004.
Of the three types of primary headache, migraine has received the most attention from medical researchers, and a large number of studies have examined its correlates.
For instance, there is evidence that migraine headache is more common among whites as compared to blacks or Asians Stewart, Lipton, and Liberman 1996; Lipton
et al. 2001, and there is evidence that it is negatively correlated with commonly used measures of socioeconomic status Stewart et al. 1992; Lipton et al. 2001;
Waldie et al. 2002; Lipton et al. 2007. Although sufferers will attest to its power to seriously disrupt daily life, no previous study has attempted to assess the causal
effect of migraine headache on educational attainment or earnings. Such an assess- ment is necessary in order to accurately estimate the full economic cost of migraine
headache.
Using data from the National Longitudinal Study of Adolescent Health, this study examines the effect of migraine headache on three measures of educational attain-
ment: high school grade point average, the probability of graduating high school, and the probability of attending college. Ordinary least squares OLS and propensity
score matching PSM estimates suggest that migraine headache is negatively related to educational attainment. These estimates, however, could reflect difficult-to-mea-
sure factors at the family level. In order to account for the influence of family-level unobservables, we investigate the effect migraine headache through an examination
of siblings raised in the same household. Estimates based on sibling data confirm the negative relationship produced by OLS and PSM. Controlling for excused ab-
sences from school, trouble paying attention during class, and trouble completing homework reduces, but does not eliminate, the estimated effect of migraine headache
on educational attainment.
II. Background
