To assess the association between lifestyle factors, substance use, and frequent recurrent headaches in youth.

We hypothesized that higher odds of frequent headaches would be associated with several lifestyle factors and frequent substance use in youth.

This was an observational study of youth aged 5-17 using data from a population-based health survey (2019 Canadian Health Survey on Children and Youth). Headache frequency was dichotomized as ‘about once a week or less’ or ‘>once a week’ (defined as frequent recurrent headaches). Logistic regression was used to quantify the association between frequent headaches and meal schedules, prolonged screen exposure (≥21h in past week), physical activity (≥60 minutes/day), chronotype, frequent substance use (alcohol ≥1/week, binge drinking ≥5 times in past month, daily smoking, daily e-cigarettes, daily cannabis), and exposure to daily smoking in the household, unadjusted and adjusted for age and sex. Design effects were addressed using bootstrap replicate weighting. 

There were 4,978,370 youth (weighted sample size) (mean age=10.9 years, 48.8% females) and 6.1% had frequent headaches. Age and female sex were associated with frequent headaches (OR=1.31, 95%CI=1.28-1.34, and 2.39, 95%CI=2.08-2.75, respectively). In models adjusted for age/sex, the odds of frequent headaches decreased with meal regularity (OR=0.90, 95%CI=0.89-0.92) and increased with later chronotype (OR=1.10, 95%CI=1.05-1.15) and excess screen exposure (OR=2.97, 95%CI=1.53-5.77); there was no significant association with physical activity. In adolescents 12-17 years old, frequent headaches were associated with alcohol use (OR=3.50, 95%CI=2.18- 5.62), binge drinking (OR=5.52, 95%CI=2.95-10.32), smoking cigarettes (OR=3.81, 95%CI=1.91-7.62), using e-cigarettes (OR=3.10, 95%CI=2.29-4.20), and cannabis use (OR=3.59, 95%CI=2.0-6.45). Smoking inside the house was associated with higher odds of frequent headaches in youth of all ages (OR=2.00, 95%CI=1.23-3.27).