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

Overview

Abstract (English)

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 nweighted = 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, p < 0.001) and female sex (OR = 2.39, 95% CI 2.08–2.75, p < 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, p < 0.001) and increased with later chronotype (aOR = 1.10, 95% CI 1.05–1.15, p < 0.001) and excess screen exposure (?21 hours vs none in past week: aOR = 2.97, 95% CI 1.53–5.77, p = 0.001); there was no significant association with reported physical activity (aOR = 0.95, 95% CI 0.67–1.34, p = 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, p < 0.001), binge drinking (?5 times in past month vs never: aOR = 5.52, 95% CI 2.95–10.32, p < 0.001), smoking cigarettes (daily vs never: aOR = 3.81, 95% CI 1.91–7.62, p < 0.001), using e-cigarettes (daily vs never: aOR = 3.10, 95% CI 2.29–4.20, p < 0.001), and cannabis use (daily vs never: aOR = 3.59, 95% CI 2.0–6.45, p < 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, p = 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.

Abstract (French)

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