Red Blood Cell Distribution Width-to-Albumin Ratio and Migraine: Associations with Prevalence and All-Cause Mortality in a Population-Based Study

Migraine is a common primary neurovascular disorder associated with substantial morbidity and systemic inflammatory alterations. The red blood cell distribution width-to-albumin ratio (RDW-to-albumin ratio, RAR) is an emerging marker of systemic inflammation and nutritional status; however, standardized approaches for evaluating its association with migraine outcomes in large population datasets are limited. Using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004, this study evaluated the relationship between RAR and migraine prevalence, as well as all-cause mortality among individuals with migraine. A total of 8,781 participants were included in the cross-sectional analysis, and 1,762 participants with migraine were followed for mortality outcomes. Multivariable logistic and Cox regression models were used to assess the associations. After adjusting for potential confounders, higher RAR levels were significantly associated with an increased likelihood of migraine. Among participants with migraine, elevated RAR was also independently associated with higher all-cause mortality. These findings suggest that RAR may serve as a simple and accessible biomarker for identifying individuals at higher risk of migraine and adverse outcomes, highlighting its potential value in risk stratification and clinical management.