Teens who have been bullied by their peers, or who have considered or attempted suicide, may be more likely to have more frequent headaches than teens who have not experienced any of these problems, according to a study published in the August 2, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study does not prove that bullying or thoughts of suicide cause headaches; it only shows an association.
Headaches are a common problem for teenagers, but our study looked beyond the biological factors to also consider the psychological and social factors that are associated with headaches. Our findings suggest that bullying and attempting or considering suicide may be linked to frequent headaches in teenagers, independent of mood and anxiety disorders."
Serena L. Orr, MD, MSc, study author, University of Calgary in Canada
The study involved more than 2.2 million teens with an average age of 14 years. Of the total participants, 0.5% self-reported being gender diverse, meaning being transgender or self-reporting as being gender diverse including being gender nonbinary.
Participants completed questionnaires about their headaches. They were asked if they had headaches in the past six months and at which frequency: rarely or never, about once a month, about once a week, more than once a week, or most days. Participants also answered questions regarding mental health including whether they had diagnosed mood or anxiety disorders, or both. They were asked if they were bullied in the past year and if they were, at what frequency. Lastly, they were asked whether they had suicidal thoughts in the past year and if they had any suicide attempts in their lifetime.
Of the participants, 11% reported having frequent, recurring headaches, defined as headaches occurring more than once a week. A total of 25% of the participants reported being victims of frequent overt bullying, including physical and verbal aggression, being called names or insulted, and being threatened virtually; and 17% reported being victims of frequent relational bullying, including having rumors spread about them, being excluded, and having harmful information posted about them on the internet. Also, 17% of participants reported considering or attempting suicide in their lifetime.
Researchers found that those who had frequent headaches were nearly three times more likely to experience bullying than their peers. Teenagers who had been bullied or had suicidal tendencies were nearly twice as likely to have frequent headaches as their peers, while those with mood and anxiety disorders were 50% and 74% more likely, respectively, to have frequent headaches than their peers.
Researchers found that 34% of teens with frequent headaches reported being victims of relational bullying at least once a month compared to 14% of teens who had headaches less than once a week. They also found that 34% of teens with frequent headaches had made one or more suicide attempts or had suicidal thoughts compared to 14% of teens with headaches less than once a week.
After adjusting for age and sex, researchers found that teenagers who reported being gender diverse were more likely to have frequent headaches. However, that link disappeared after adjusting for additional factors including being bullied or having a diagnosed mood or anxiety disorder.
"Though gender diverse teens appear to have a higher risk of frequent, recurring headaches, this association disappears after controlling for bullying, anxiety, depression, and suicidal tendencies, suggesting that perhaps gender diversity is not, in and of itself, related to frequent headaches, but that the psychosocial factors associated with it may explain this link," Orr said. "This is important information because these factors are preventable and treatable, and as such, must be examined further."
"These results should compel future research into interventions for bullying and a better understanding of how gender diverse youth are at a higher risk of headache disorders," Orr said. "These findings should urge policymakers to increase efforts towards bullying prevention and should encourage doctors to screen children and teens with headache disorders for bullying and suicidal tendencies."
A limitation of the study was that participants self-reported their headaches and other information and they may not have remembered all the information accurately.
Nilles, C., et al. (2023) Association Between Peer Victimization, Gender Diversity, Mental Health, and Recurrent Headaches in Adolescents: A Canadian Population-Based Study. Neuroimage: Clinical. doi.org/10.1212/WNL.0000000000207738.