School of Social Work, The University of Texas at Arlington, Arlington, TX, USA.
University of North Carolina, at Chapel Hill, School of Social Work, Chapel Hill, NC, USA.
Headache. 2021 Apr;61(4):673-682. doi: 10.1111/head.14098.
Adverse childhood experiences (ACEs) are commonly observed in the general population and often have lasting neurological and physiological effects. Previous studies have found links between exposure to ACEs, headaches, and functional difficulties in adults. However, little is known about the mechanisms through which exposure to ACEs is associated with headaches among children.
To examine the association between exposure to ACEs and headaches in children, and whether functional difficulties mediate this association.
Data for this cross-sectional secondary analysis study came from the 2017-2018 National Survey of Children's Health. The sample analyzed in this study was 40,953 children who were between ages 3 and 17 years. We adjusted for the complexity of the sampling design and used structural equation modeling to examine the mediating effect of functional difficulties in the association between exposure to ACEs and headaches.
Based on parent reports, we found that 4.1% (1697/40,953) of the children reported frequent or severe headaches, and 9.5% (3906/40,953) were exposed to three or more ACEs. About one in four children (23.4%; 9601/40,953) had at least one functional difficulty. The results show that exposure to ACEs was directly positively associated with functional difficulties (β = 0.16, p < 0.001, 95% CI = 0.15-0.17), and functional difficulties were in turn positively associated with headaches (β = 0.17, p < 0.001, 95% CI = 0.12-0.22). The Sobel test of indirect effect showed that functional difficulties partially mediated the association between exposure to ACEs and headaches (β = 0.027, p < 0.001, 95% CI = 0.022-0.029). Also, older children and children with brain injury were more likely to report experiencing headaches.
The findings from this study suggest an association between exposure to ACEs and headaches among children, and functional difficulties partially mediate this association.
不良童年经历（ACEs）在普通人群中很常见，往往会对神经系统和生理机能产生持久影响。既往研究发现，ACEs 暴露与成年人头痛和功能障碍之间存在关联。然而，对于 ACEs 暴露与儿童头痛之间的关联机制，我们知之甚少。
探讨儿童 ACEs 暴露与头痛之间的关系，以及功能障碍是否在其中起中介作用。
本横断面二次分析研究的数据来自 2017-2018 年全国儿童健康调查。本研究分析的样本为 3 至 17 岁的 40953 名儿童。我们对抽样设计的复杂性进行了调整，并采用结构方程模型来检验 ACEs 暴露与头痛之间关联中功能障碍的中介作用。
根据家长报告，我们发现 4.1%（1697/40953）的儿童报告经常或严重头痛，9.5%（3906/40953）的儿童暴露于三种或更多 ACEs。约四分之一的儿童（23.4%；9601/40953）存在至少一种功能障碍。结果显示，ACEs 暴露与功能障碍呈直接正相关（β=0.16，p<0.001，95%CI=0.15-0.17），而功能障碍又与头痛呈正相关（β=0.17，p<0.001，95%CI=0.12-0.22）。间接效应的 Sobel 检验表明，功能障碍部分中介了 ACEs 暴露与头痛之间的关联（β=0.027，p<0.001，95%CI=0.022-0.029）。此外，年龄较大的儿童和有脑损伤的儿童更有可能报告头痛。
本研究结果提示儿童 ACEs 暴露与头痛之间存在关联，功能障碍部分中介了这种关联。
