Lifestyle Factors Associated With Frequent Recurrent Headaches in Children and Adolescents: A Canadian Population-Based Study.

Neurology

From the Department of Clinical Neurosciences (C.N., S.B.P., T.M.P.), Psychiatry, Pediatrics and Community Health Sciences; Department of Community Health Sciences (J.V.W.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.B.P., T.M.P., S.L.O.); Hotchkiss Brain Institute (T.M.P., S.L.O.); Department of Clinical Neurosciences (T.M.P., S.L.O.); and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.

Published: March 2024

Background And Objectives: Lifestyle behaviors have been postulated to affect headache frequency in youth and are often the primary target of self-management recommendations. Our study aimed to assess the association between various lifestyle factors and frequent recurrent headaches in children and youth.

Methods: Children and adolescents aged 5-17 years were enrolled in a large cross-sectional Canadian population-based health survey, completed on January 31, 2019. Headache frequency was dichotomized into "approximately once/week or less" or ">once/week" (defined as frequent recurrent headaches). The association between frequent headaches and meal schedules, screen exposure, physical activity, chronotype, and frequent substance use/exposure (alcohol, cigarettes, electronic cigarettes, and cannabis) was assessed using both unadjusted logistic regression models and models adjusted for age/sex. Fully adjusted models examined the odds of frequent headaches according to all exposures. Survey design effects were accounted for using bootstrap replicate weighting.

Results: There were an estimated n = 4,978,370 eligible participants in the population. The mean age was 10.9 years (95% CI 10.9-11.0); 48.8% were female; 6.1% had frequent headaches. Frequent headaches were associated with older age (odds ratio [OR] = 1.31, 95% CI 1.28-1.34, < 0.001) and female sex (OR = 2.39, 95% CI 2.08-2.75, < 0.001). In models adjusted for age/sex, the odds of frequent headaches decreased with meal regularity (adjusted OR [aOR] = 0.90, 95% CI 0.89-0.92, < 0.001) and increased with later chronotype (aOR = 1.10, 95% CI 1.05-1.15, < 0.001) and excess screen exposure (≥21 hours vs none in past week: aOR = 2.97, 95% CI 1.53-5.77, = 0.001); there was no significant association with reported physical activity (aOR = 0.95, 95% CI 0.67-1.34, = 0.77). In 12- to 17-year-olds, frequent headaches were associated with frequent alcohol use (≥1/wk vs never: aOR = 3.50, 95% CI 2.18-5.62, < 0.001), binge drinking (≥5 times in past month vs never: aOR = 5.52, 95% CI 2.95-10.32, < 0.001), smoking cigarettes (daily vs never: aOR = 3.81, 95% CI 1.91-7.62, < 0.001), using e-cigarettes (daily vs never: aOR = 3.10, 95% CI 2.29-4.20, < 0.001), and cannabis use (daily vs never: aOR = 3.59, 95% CI 2.0-6.45, < 0.001). In the entire sample, daily exposure to smoking inside the house was associated with frequent headaches (aOR = 2.00, 95% CI 1.23-3.27, = 0.005).

Discussion: Several lifestyle behaviors were associated with frequent headaches in children and youth, such as meal irregularity, late chronotype, prolonged screen exposure, and frequent substance use/exposure, suggesting that these are potential modifiable risk factors to target in this population.

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http://dx.doi.org/10.1212/WNL.0000000000209160DOI Listing

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