Early Life Stress in Adolescent Migraine and the Mediational Influence of Symptoms of Depression and Anxiety in a Canadian Cohort

Abstract

Objective This study sought to examine the association between early life stressors and adolescent headache in the Canadian population, and the potential mediating influence of symptoms of depression and anxiety. Background Early life stress or adverse childhood experiences have a well‐documented association with migraine and headache in adulthood, as do symptoms of depression and anxiety. However, there is limited evidence examining the relationship between early life environmental stressors and adolescent headache, and a lack of longitudinal research. Family‐level factors including parenting behaviors and parental influences such as maternal distress have been implicated in pediatric chronic pain. Methods This study used data from 2313 respondents of the National Longitudinal Survey of Children and Youth, followed prospectively from age 0 to 1 years at baseline (1994/1995) until age 14 to 15 years (2008/2009). The relationships between 4 measures of early life family level stressors, and outcomes of incident health professional‐diagnosed migraine and self‐reported, unclassified frequent headache (>1 per week) were examined. We conducted a series of mediation analyses of the indirect effect (IE) of family‐level stressors on headache outcomes through symptoms of depression and anxiety in late childhood. The IE and 95% bias‐corrected confidence interval (CIBC) were estimated using maximum likelihood logistic regression methods (log odds scale). Results The proportion of respondents with incident migraine and frequent headache was 3.1% and 11.1%, respectively. There were no direct associations between distal early life family‐level factors and adolescent headache. Symptoms of depression‐ and anxiety‐mediated relationships between family dysfunction (IE 0.0181, 95% CIBC 0.0001‐0.0570), punitive parenting (IE 0.0241, 95% CIBC 0.0015‐0.0633), parental depressive symptomatology (IE 0.0416, 95% CIBC 0.0017‐0.0861), and incident migraine but not frequent headache. Indirectly, presence of family dysfunction, punitive parenting, and higher parental depressive symptomatology in early life were associated with a greater likelihood of migraine in adolescence, through greater symptoms of depression and anxiety in late childhood. Conclusions Findings provide support for the influence of early life family‐level factors on prospective risk of developing migraine, through symptoms of depression and anxiety. Addressing family dynamics in clinical practice may reduce unnecessary stress‐related burdens on children and adolescents, which could lead to improvements in their somatic complaints.

Insomnia May Mediate the Relationship Between Stress and Anxiety: A Cross-Sectional Study in University Students

“…49 Moreover, estimates may vary, but studies showed that patients having a diagnosis of mental health issues like stress had shown ~65% likelihood of having other comorbid mental health disorders. 49,50 Consistently, each mental health disorder may exacerbate the other, impeding the patient's recovery cycle. 51 Clinically, this finding supports the existing literature and optimizes the present clinical guidelines in the management of insomnia and prevent future predisposition of the patient to anxiety and other mental health disorders.…”

A Review on the Triggers of Pediatric Migraine with the Aim of Improving Headache Education

“…These stresses can exacerbate a migraine, which in turn reduces further functioning [ 29 , 34 ], impairs the health-related quality of life [ 28 , 89 ], and affects relationships with colleagues [ 90 ]. Ensuring healthy family dynamics as part of routine consultations may reduce unnecessary stressful burdens on children and adolescents and improve their physical complaints [ 25 ]. Understanding that migraines are associated with family [ 91 ] and building better relationships to form a solid support system will reduce migraines in affected children.…”

“…The most problematic and common trigger for pediatric migraines is stress [ 23 , 24 ]. Several reports have suggested that stressful home [ 25 , 26 ] and school [ 27 , 28 , 29 ] environments aid migraine attacks. The brain structure becomes disrupted by stress due to multifactorial and epigenetic processes that alter gene expression [ 30 , 31 ].…”

“…A recent longitudinal cohort study on 2313 respondents who were followed prospectively from 0–1 year of age (baseline) until 14–15 years detected depression- and anxiety-mediated relationships between family dysfunction, punitive parenting, and parental depressive symptomatology only in patients with migraine. The presence of these family-level stressors early in life was associated with a higher likelihood of adolescent migraine and increased symptoms of depression and anxiety in late childhood [ 25 ]. Therefore, if psychiatric comorbidities are detected in a patient, they should be addressed in a timely fashion and managed appropriately to prevent the development of migraines in the future.…”

Virtual issue: Kids (with headache disorders) are not just little adults (with headache disorders)

“…3 In this issue, we present the work that highlights the importance of the unique biopsychosocial factors that play a key role in the incidence and prognosis of pediatric headache disorders. From the importance of parental factors and early life stress in determining headache incidence and trajectories, [4][5][6] to considering the impact of societal policies on children and adolescents with headache disorders such as school start times, 7 we are starting to learn more about the biopsychosocial factors that are key to understand how pediatric headache disorders develop and how they are maintained.…”