Migraine and its association with pubertal maturation and behavioral traits among adolescent girls

Objective: To determine if the ages at pubertal milestones are associated with the prevalence of adolescent migraine. Background: Migraine headaches are a common disease in adolescent girls. Past studies have evaluated the relationship between age of onset of menarche and migraine headache, but none have studied earlier pubertal milestones such as thelarche and pubarche. Methods: In this cross-sectional study, a previously validated questionnaire was administered to girls (15–18 years) in Breast Cancer and the Environment Research Program puberty cohort to ascertain if they met criteria for migraine over the past year. Ages of pubertal development were ascertained by serial examinations beginning at 6–8 years of age and ending in late puberty. Logistic regression analyses determined if age of onset of each pubertal milestone (thelarche, pubarche, menarche separately) was associated with adolescent migraine after adjusting for other risk factors. Results: Of 761girls, 222 (29.2%) met the criteria for migraine. Later thelarche was associated with a lower odds of adolescent migraine (OR 0.83; 95% CI 0.72–0.97, p = 0.019). In models further adjusted for BASC-2 internalizing problems (n = 490), both later thelarche (OR 0.78; 95% CI 0.64–0.96, p = 0.016) and later menarche (OR 0.81; 95%CI 0.67–0.98, p = 0.026) were associated with a lower migraine prevalence. Internalizing problems (OR 1.05; 95% CI 1.03–1.07) externalizing problems (OR 1.05; 95% CI 1.02–1.07) and behavioral symptoms (OR 1.05; 95% CI 1.03–1.08) were associated with increased prevalence of migraine in separate models. Conclusions: Age of onset of thelarche and menarche, and internalizing, externalizing, and behavioral symptoms were all associated with adolescent migraine.