Date of Award

January 2026

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jeffrey M. Cohen

Abstract

Recent studies have found an association between acne and migraine in adults; however, studies examining this relationship in adolescents are limited. To investigate the association between acne and migraine, we conducted a retrospective cohort study using the National Institutes of Health All of Us Research Program. We included adult participants in this program whose electronic health record had at least one documented condition during adolescence (ages 10-19). We matched individuals with acne during adolescence to individuals without acne during adolescence using nearest-neighbor propensity score matching, with replacement based on demographic factors. We then estimated the odds of migraine during adolescence among individuals with acne compared to controls, adjusting for assigned sex at birth, race, and ethnicity in the primary model, as well as comorbid major depressive disorder (MDD) and generalized anxiety disorder (GAD) in a fully adjusted model. Individuals with rosacea at any age were excluded from the study as rosacea is associated with migraine and could potentially be misclassified as acne.

In total, there were 902 patients with acne and 1688 controls. The unadjusted prevalence of migraine was significantly higher among adolescents with acne (14%) than those without acne (3.8%). After adjusting for demographics including assigned sex at birth, race, and ethnicity; as well as comorbid MDD and GAD, the odds of migraine were higher among the acne patients compared to the controls (Odds Ratio [OR], 2.92; 95% CI, 2.10–4.10; p < 0.001). Furthermore, those with acne first documented between the ages of 15 and 19 had decreased odds of migraine compared to those who had an earlier diagnosis (ages 10-14) after adjusting for demographics and comorbid MDD and GAD (OR, 0.58; 95% CI, 0.37–0.92; p = 0.017).

We found a positive association between acne and migraine during adolescence, even after controlling for GAD and MDD status. These results suggest the need for further investigation into possible shared mechanisms linking acne and migraine; as well as treatments that could benefit those with both conditions, including targeting Calcitonin gene-related peptide (CGRP)-mediated pathways.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 07/14/2028

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