Cephalalgia Reports · Published 2026-07-01 · DOI 10.1177/25158163261474168
Fares Qeadan, Maryana Nissan, Rose Thornquist
Aim Migraine is prevalent in college populations and commonly co-occurs with mental health conditions. This study assessed whether self-reported migraine-related healthcare interaction status was associated with substance use indicators among U.S. college students engaged in migraine-related care and the extent to which measured mental health diagnoses statistically explained these associations. Methods We analyzed pooled repeated cross-sectional data from the American College Health Association-National College Health Assessment (ACHA-NCHA III/IIIb; Fall 2019-Spring 2025). The analytic sample included 37,982 students reporting a migraine-related appointment/discussion within the past 12 months. The exposure was self-reported migraine-related healthcare interaction status, categorized as received treatment, appointment/discussion without treatment, or told no treatment was necessary. Outcomes were binary indicators of past-30-day alcohol use and cannabis use (including medical and non-medical use), past-2-week binge drinking, past-3-month non-medical prescription drug misuse and other illegal drug use, polysubstance use, and alcohol-prescription drug co-use (co-reporting). Associations were estimated using multivariable logistic regression. Exploratory four-way decomposition was used to assess the extent to which depression, anxiety, or posttraumatic stress disorder (PTSD) statistically explained selected associations. Results Most students reported receiving migraine treatment (76.9%); 15.3% reported an appointment/discussion without treatment and 7.8% reported being told no treatment was necessary. Compared with students who received treatment, those reporting an appointment/discussion without treatment had higher adjusted odds of alcohol use (adjusted odds ratio [aOR]:1.088, 95% confidence interval [CI]: 1.022–1.159), binge drinking (aOR: 1.186, 95% CI: 1.104–1.275), cannabis use (aOR: 1.222, 95% CI: 1.142–1.309), other illegal drug use (aOR: 1.227, 95% CI: 1.074–1.403), and polysubstance use (aOR: 1.213, 95% CI: 1.131–1.300). Students told no treatment was necessary showed a broadly similar pattern across these outcomes. Co-use of alcohol with prescription drugs was not statistically significant after adjustment. Exploratory decomposition suggested that measured depression, anxiety, or PTSD accounted for a modest proportion of cannabis and polysubstance associations; other estimates, particularly interaction-related components for other illegal drug use, were unstable and interpreted cautiously. Conclusions Among U.S. college students engaged in migraine-related care, self-reported healthcare interaction categories indicating an appointment/discussion without treatment or being told no treatment was necessary were associated with modestly higher odds of several substance use indicators. These categories should be interpreted as healthcare interaction categories rather than measures of treatment adequacy. Findings support hypothesis-generating attention to integrated migraine-related care and substance-use screening in college health settings.
Abstract from DOAJ. Public domain (CC0 1.0).
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Qeadan, F., Nissan, M., Thornquist, R. (2026). Migraine-Related healthcare interaction status and substance use among U.S. college students: Evidence from the ACHA-NCHA. Cephalalgia Reports. https://doi.org/10.1177/25158163261474168