Family dysfunction, punitive parenting, and parental depression increase the risk for migraine in adolescents, a risk mediated by symptoms of depression and anxiety in late childhood, according to a study in Headache.

Data from respondents of the National Longitudinal Survey of Children and Youth were included in the study (n=2313). Respondents were followed prospectively from 0 to 1 year of age at baseline to age 14 to 15 years (1994/1995 and 2008/2009, respectively). Canadian researchers examined the association between measures of early life family-level stressors with outcomes of clinician-diagnosed migraine and self-reported unclassified frequent headache >1 per week. The 12-item Family Functioning Scale was used to measure family dysfunction and the 12-item version of the Centre for Epidemiological Studies Depression scale was used to measure depressive symptoms.

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In the overall cohort, respondents had incident migraine (3.1%) and frequent headache (11.1%). The investigators found a mediating relationship between symptoms of depression and anxiety with family dysfunction (indirect effect [IE], 0.0181; 95% CIbias corrected[BC], 0.0001-0.0570), punitive parenting (IE, 0.0241; 95% CIBC, 0.0015-0.0633), and parental depressive symptomatology (IE, 0.0416; 95% CIBC, 0.0017-0.0861).

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In the adjusted post hoc analysis, there was a significant IE of parental depressive symptoms (IE, 0.0777; 95% CIBC, 0.0032-0.1587) and number of stressors (IE, 0.0291; 95% CIBC, 0.0004-0.0619) on migraine. Respondents were 1.08 times (95% CI, 1.00-1.17) more likely to report migraine at follow-up if they reported higher parental depressive symptoms, and respondents were 1.03 times (95% CI, 1.00-1.06) more likely to report migraine at follow-up if they reported a greater number of stressors during childhood.

Limitations of the study included residual confounding from unconsidered factors (eg, school performance) and the lack of data to distinguish common features in the frequent headache subgroup.

“This knowledge should help to inform better clinical assessment of headache and identify mechanisms not within the control of the child that may alter their development of adverse health outcomes,” the researchers concluded.


Hammond NG, Orr SL, Colman I. Early life stress in adolescent migraine and the mediational influence of symptoms of depression and anxiety in a Canadian cohort [published online September 16, 2019]. Headache. doi:10.1111/head.13644