Frequent recurrent headaches linked to bullying, suicidality in adolescents

Key takeaways:

• Cross-sectional study examined data from more than 2 million Canadian youths on frequency of headache and bullying.
• Frequent recurrent headaches were linked to overt and relational bullying and suicidality.

Peer victimization and suicidality were associated with higher headache frequency in adolescents, while the association between headache and gender diversity weakened after controlling for other factors, according to research in Neurology.

“While most population-based studies of children and adolescents with headache have focused on defining incidence and prevalence of primary headache disorders, there is a clear gap in the literature with regards to understanding social factors that may influence the experience of pain in this population,” Christelle Nilles, MD, from the department of clinical neurosciences, psychiatry, pediatrics and community health sciences at the University of Calgary, and colleagues wrote.

Nilles and fellow researchers sought to examine associations between peer victimization, gender diversity and recurrence of headaches in adolescents, while controlling for age, sex, socioeconomic status, mood and anxiety disorders, and suicidality.

They conducted a cross-sectional, observational study of youths aged 12 to 17 years, utilizing data from the 2019 Canadian Health Survey on Children and Youth, which had an overall response rate of 52%.

Respondents answered survey questions about headache frequency and peer victimization, or bullying, among others. Researchers categorized headache frequency in the past 6 months as once a week or less or more than once a week and frequency of bullying in the previous 12 months as never or infrequently or monthly or frequently. They further classified bullying as overt, which includes physical or verbal aggression, and relational, which includes exclusionary actions, gossip and threats to social status.

Of 2,268,840 eligible individuals (mean age, 14.4 years; 48.8% girls; 0.5% gender diverse), 112% reported frequent recurrent headaches, 24.77% experienced frequent overt bullying and 16.63% reported frequent relational bullying. In addition, 3.81% were diagnosed with a mood disorder and 7.38% an anxiety disorder. More than 16% reported considering or attempting suicide.

Researchers also used multiple analytical models to quantify the association between frequent bullying, gender diversity, mood or anxiety disorders, and suicidality with odds of frequent recurrent headaches.

According to results, frequent recurrent headaches were significantly associated with older age (OR = 1.26 per year of age; 95% CI, 1.2-1.31), female sex (OR = 2.89; 95% CI, 2.47-3.37) and, after adjusting for age and sex, being gender diverse (OR = 3.3; 95% CI, 1.64-6.63).

Individuals with frequent headaches also had higher odds of experiencing both overt (OR = 2.69; 95% CI, 2.31-3.14) and relational bullying (OR = 3.03; 95% CI, 2.58-3.54) compared with peers, after adjusting for age and sex.

After fully adjusted multivariable analysis, researchers reported that gender diversity and frequent recurrent headaches were no longer significantly associated with one another. However, frequent overt and relational bullying (adjusted OR = 1.82; 95% CI, 1.41-2.34 and aOR = 1.54; 95% CI, 1.17-2.03, respectively), suicidality (aOR = 1.83; 95% CI, 1.44-2.32) and having a mood or anxiety disorder (aOR = 1.5; 95% CI, 1.01-2.21 and aOR = 1.74; 95% CI, 1.24-2.45, respectively) were still significantly associated with higher odds of frequent recurrent headaches.

“The results of this study should compel future research into interventions for peer victimization and future work aimed at better understanding if and how gender diverse youth are at higher risk of headache disorders,” Nilles and colleagues wrote.