Adverse childhood experiences and onset of migraine in Canadian adolescents: A cohort study.

Abstract

Adverse childhood experiences (ACEs) are cross-sectionally associated with headache, including migraine, in pediatric populations. The objective of this study was to determine whether ACEs are prospectively associated with incident health-professional diagnosed migraine and prevalence of non-migraine frequent headache in adolescence, either directly or indirectly through symptoms of depression and anxiety. We used data from the National Longitudinal Survey of Children and Youth, a Canadian cohort study that followed children aged 0/1 at baseline, and the person most knowledgeable about them (PMK) until the child reached adolescence. The PMK reported on 14 ACEs (e.g., parental death) when the child was 4/5 and 6/7 years, and symptoms of depression and anxiety in late childhood (age 8/9 years), using a validated tool. Migraine (primary outcome) was ascertained via PMK report of a health-professional diagnosis, and non-migraine frequent headache (>1 time per week) was adolescent self-report, both measured at age 14/15. We estimated direct and indirect effects (IEs) on the log-odds scale through symptoms of depression and anxiety (mediator). We adjusted for sex, parental migraine, and economic deprivation. The analytic sample sizes were: n=2058 (migraine) and n=1730 (frequent headache). There were nunweighted =71 respondents with migraine (3.4%, 71/2058) and nunweighted =204 with non-migraine frequent headache (11.8%, 204/1730). Most respondents experienced no ACEs (weighted percentage=55.7), followed by 1 ACE (weighted percentage=34.7) and greater than or equal to two ACEs (weighted percentage=9.6), respectively. There were direct associations between experiencing one (odds ratio [OR]=1.71, 95% confidence interval [CI]: 1.01-2.87) and equal to or greater than two (OR=2.33, 95% CI: 1.13-4.80) ACEs and migraine, but not for non-migraine frequent headache. There were no indirect relationships through symptoms of depression and anxiety for migraine (1 ACE: OR=1.06, 95% CI: 0.99-1.13 and ≥2 ACEs: OR=1.11, 95% CI: 0.98-1.28) or non-migraine frequent headache (1 ACE: OR=0.99, 95% CI: 0.95-1.03 and ≥2 ACEs: OR=0.98, 95% CI: 0.90-1.07). ACEs may confer an increased risk of migraine onset in adolescence. The association was not explained by symptoms of depression and anxiety in late childhood.