Date of Award


Document Type

Open Access Thesis


Epidemiology and Biostatistics


The Norman J. Arnold School of Public Health

First Advisor

Anwar Merchant


Headaches are the sixth leading cause of disability worldwide, and the third leading cause of disability amongst those aged 50 and older. Several headache disorders, including migraines, have been associated with nitric oxide production. It is widely accepted that the pain associated with headache disorders is due to the ability of nitric oxide to function as a vasodilator. While nitric oxide is a known vasodilator and has been linked to headache disorder, it is also produced in response to bacterial infections. Periodontal disease is the result of long term bacterial infections occurring in the gum line and nitric oxide is produced in response. Because periodontal disease incites the production of nitric oxide, it is biologically plausible that periodontal disease could be associated with headache disorders.

To investigate the relationship between periodontal disease and headache disorders, bivariate and ordinal logistic regressions were employed while controlling for age, education, income, physical activity level, smoking status, body mass index, and diet. The population consisted of 1206, postmenopausal women from the Women’s Health Initiative.

While our study reports no significant association between periodontal disease and headache disorders, our study did provide evidence of a link between Porphyromonas gingivalis, an important microbe in periodontal disease pathogenesis capable of inducing nitric oxide production, and migraines (Odds ratio = 2.252; 95% Confidence interval: 1.121 to 4.526).

P. gingivalis presence is positively associated with migraines among older white women after controlling for potential confounders. Further investigation into measures of oral health, oral microbes, and NO in relation to headache disorders is warranted.


© 2017, Bryn E. Davis

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