Functional difficulties mediate the association between exposure to adverse childhood experiences and headaches among children: Findings from a population‐based study

Abstract

Background 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. Objective To examine the association between exposure to ACEs and headaches in children, and whether functional difficulties mediate this association. Methods 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. Results 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. Conclusions The findings from this study suggest an association between exposure to ACEs and headaches among children, and functional difficulties partially mediate this association.

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

“…Similarly, others have observed cross-sectional relationships between the number of ACEs and headache but did not investigate migraine independently. 5,6 Within the present study, the magnitude of the observed direct associations between the number of ACEs and incident health-professional diagnosed migraine are consistent with the associations reported in the other pediatric studies. [3][4][5][6] Because the number of adverse events tapered off quickly following two, we could not examine associations beyond two or more stressors.…”

“…5,6 Within the present study, the magnitude of the observed direct associations between the number of ACEs and incident health-professional diagnosed migraine are consistent with the associations reported in the other pediatric studies. [3][4][5][6] Because the number of adverse events tapered off quickly following two, we could not examine associations beyond two or more stressors.…”

“…Cross-sectional evidence has demonstrated associations between ACEs and chronic pain, 3 including migraine and other headache disorders, in children and adolescents. [4][5][6] To our knowledge, to date, no study has provided longitudinal evidence for a relationship between reported ACEs and the onset of headache disorders before adulthood.…”

The relationship of childhood adversity and migraine and the value of prospective studies

“…Further limitations among the morass of cross-sectional studies in adults included incomplete characterization of types, frequency, and temporal sequence of ACEs and headache. Studies of ACEs and headache in children and adolescents are fewer, [10][11][12][13][14][15][16][17] and although they minimize some of the limitations of adult studies, potential obstacles to getting valid information remain. Youthful participants, for instance, may be reluctant to report abuse due to fear of punishment or rejection, and their parents may deny maltreatment because they are unaware, or wish to shield themselves or perpetrators in the household from blame, thus leading to underestimation of the prevalence of ACEs.…”