College of Public Health, University of South Florida, Tampa, FL, USA.
Headache. 2020 Apr;60(4):735-744. doi: 10.1111/head.13773. Epub 2020 Feb 17.
This cross-sectional study examined the association between adverse childhood experiences (ACEs) and history of frequent headaches (including migraine) among children 3-17 years old using data from the 2016 and 2017 U.S. National Survey of Children's Health (NSCH).
ACEs include abuse (physical, emotional, or sexual), parental divorce, death, mental illness, or addiction, and are linked to higher morbidity and mortality in adulthood. A relationship between ACEs and headaches exists among adults, but studies examining the relationship among children are lacking. To our knowledge, no studies have examined the link among children using NSCH data.
The NSCH is a nationally representative survey of U.S. children's physical and emotional well-being aimed at understanding their health needs. Parental-reported information was collected on child history of headaches and 9 ACEs for the selected child. The survey collected information on 71,881 children in 2016 and 2017 out of which 61,565 were eligible for the study (age ≥3 years and not missing data on history headaches). Children with missing values for headache, ACEs, or covariates (n = 58,958) were excluded from the final analysis. We used multivariable logistic regression with survey weighting and adjusted for demographics and comorbidities (anxiety, depression, epilepsy, and brain injury) to examine the association between ACEs and headaches overall and stratified by gender. We further assessed the independent relationship between each ACE and headaches.
In the current study, out of 61,656 children, 26,884 (48.6%) experienced at least 1 ACE and 3426 (6.5%) experienced 4+ ACEs. Overall, compared with children with no ACEs, the adjusted odds of headache were 1.34 times higher among children with 1 reported ACE (95% CI: 1.07, 1.68), 2.15 times higher among children with 2 ACEs (95% CI: 1.66, 2.80), 1.89 times higher among children with 3 ACEs (95% CI: 1.40, 2.53), and 3.40 times higher among children with 4+ ACEs (95% CI: 2.61, 4.43). Females with 3 and 4+ ACEs were somewhat more likely to report headaches compared to males with the same number of ACEs. Individually, no ACE was independently associated with history of headaches except for difficulty due to family's income (aOR = 2.46, 95% CI: 1.98, 3.06).
Experiencing one or more ACEs vs none was associated with higher risk of headaches in children, and difficulty due to family's income was the only ACE independently associated with headaches. Our findings support results of other studies on ACEs and headache in young adults and suggest that adverse ACE-related health outcomes begin earlier than previously recognized. Additionally, struggling due to low income may represent a constellation of chronic stressors that independently contribute to poor health outcomes in childhood as compared to other individual ACEs. Future research should examine the importance of specific ACE clusters and stressors during childhood.
本横断面研究使用 2016 年和 2017 年美国国家儿童健康调查（NSCH）的数据，考察了儿童时期不良经历（ACEs）与频繁头痛（包括偏头痛）病史之间的关系。
ACEs 包括虐待（身体、情感或性）、父母离婚、死亡、精神疾病或成瘾，与成年后更高的发病率和死亡率有关。成年人中 ACEs 与头痛之间存在关联，但缺乏研究儿童的研究。据我们所知，没有研究使用 NSCH 数据研究儿童之间的联系。
NSCH 是一项针对美国儿童身体和情绪健康的全国性调查，旨在了解他们的健康需求。父母报告了所选儿童的头痛病史和 9 项 ACEs。该调查于 2016 年和 2017 年收集了 71881 名儿童的数据，其中 61565 名儿童符合研究条件（年龄≥3 岁，且头痛史无缺失数据）。头痛、ACEs 或协变量缺失值的儿童（n=58958）被排除在最终分析之外。我们使用多变量逻辑回归，结合调查权重，并调整了人口统计学和合并症（焦虑、抑郁、癫痫和脑损伤），以检查 ACEs 与头痛之间的总体关联，并按性别进行分层。我们进一步评估了每个 ACE 与头痛之间的独立关系。
在本研究中，在 61656 名儿童中，26884 名（48.6%）经历了至少 1 项 ACE，3426 名（6.5%）经历了 4 项以上 ACE。总体而言，与无 ACE 的儿童相比，有 1 项报告 ACE 的儿童头痛的调整后优势比为 1.34 倍（95%CI：1.07，1.68），有 2 项 ACE 的儿童为 2.15 倍（95%CI：1.66，2.80），有 3 项 ACE 的儿童为 1.89 倍（95%CI：1.40，2.53），有 4 项以上 ACE 的儿童为 3.40 倍（95%CI：2.61，4.43）。与有相同数量 ACE 的男性相比，有 3 项和 4 项以上 ACE 的女性更有可能报告头痛。单独来看，除了家庭收入困难（aOR=2.46，95%CI：1.98，3.06）外，没有任何 ACE 与头痛史独立相关。
与无 ACE 相比，经历 1 项或多项 ACE 与儿童头痛的风险增加有关，而家庭收入困难是唯一与头痛独立相关的 ACE。我们的研究结果支持其他关于 ACE 和年轻人头痛的研究结果，并表明 ACE 相关的不良健康结果比以前认为的更早开始。此外，与低收入作斗争可能代表着一系列慢性压力源，与其他个体 ACE 相比，这些压力源独立导致儿童时期健康状况不佳。未来的研究应研究特定 ACE 群集和压力源在儿童时期的重要性。
