Electronic Theses and Dissertations

Date of Award


Document Type


Degree Name

Ph.D. in Psychology



First Advisor

Todd A. Smitherman

Second Advisor

Rory Ledbetter

Third Advisor

Scott A. Gustafson

Relational Format



Migraine and tension-type headache (tth) are two of the most prevalent pain conditions diagnosed throughout the world and can be extremely disabling with many economic, social, physical and psychological health costs. A plethora of research indicates a strong, positive association between co-occurring psychiatric disorders (e.g., major depressive disorder, anxiety, panic) and migraine and tth, however co-occurring alcohol-use disorders are relatively unexplored. The limited studies that have explored alcohol-use disorders have produced mixed findings, potentially as a result of differing methodology, sample source, and the debated precipitating nature of alcohol use on headache. An abundance of research suggests that many environmental and physiological factors precipitate or "trigger" headache, including stress, hormonal fluctuations (in women), weather events, and changes in sleep and eating habits, although prevalence rates for many triggers vary greatly across studies, including alcohol (6.1- 51.5%). The inconsistencies in trigger endorsement may be influenced by the retrospective nature of most prior studies, medical advice to avoid known triggers, and various assessment approaches. Given the conflicting data regarding alcohol use and headache, the purpose of the current study was to examine existing literature related to alcohol and headache using a meta-analysis and in-depth qualitative review. The meta-analysis explored the precipitating effects of alcohol on migraine and tth. The meta-analysis and subsequent meta-regressions were run in r statistical software utilizing dersimonian-laird random-effects methods. Forty-five articles met inclusion criteria for the study. Results of the meta-analysis found significant heterogeneity across and within these 45 studies 2 = 0.95; i2 = 97.5% (95% ci: 97.1% to 97.8%), which limited interpretation. Overall, 22% (95% ci: .17 to .28) of headache sufferers ever queried about alcohol as a trigger endorsed its precipitating effect. This precipitating effect did not significantly differ between migraine and tth (p = .15) nor between migraine with and without aura (p = .90). Twenty-eight percent of individuals endorsed red wine as a trigger, 14% endorsed spirits, 12% endorsed white wine, and 10% endorsed beer or sparkling wine; however difference in endorsement rates was not significantly different (p = .06). The precipitating effect in relation to frequency and quantity of consumption was not analyzed statistically due to too few studies meeting inclusion criteria. Endorsement rates were not impacted by method of assessment. These findings aggregate the literature on alcohol as a trigger for headache and indicate future directions in research on this topic. The in-depth qualitative review highlighted three main areas of current research in nine studies that explored alcohol-use disorders (auds) and headache: 1) alcohol-use disorders among headache sufferers, 2) headache disorders among individuals diagnosed with alcohol-use disorders, and 3) problematic alcohol use (pau) assessed with validated measures among headache sufferers. In studies that explored rates of auds in headache samples, migraineurs without aura and tth sufferers did not endorse high rates of auds, however migraineurs with aura and migraineurs among a chronic pain sample did endorse higher rates of aud compared to individuals without migraine. Additionally, in studies that examined rates of headache disorders among substance use disorders inpatients, risk of migraine was significant among individuals with an alcohol dependence (but not alcohol abuse) diagnosis. Furthermore, in studies that investigated pau in headache samples, tth sufferers reported moderate rates (16.1%) of pau whereas migraineurs reported comparatively low rates (4.6%-5.2%). However, differences in validated measures used limit comparisons of these endorsement rates. Differences in this area of research suggest the need for a more uniform approach to future research on this topic.


Emphasis: Clinical Psychology



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