Frequency of Recurrent Headaches Tied to Bullying, Suicidality in Adolescents

Overt and relational bullying and suicidality were associated with the frequency of recurrent headaches in adolescents.

Peer victimization, or bullying, and suicidality are associated with frequent recurrent headaches among adolescents, according to study findings published in Neurology.

Researchers at the University of Calgary in Alberta, Canada conducted a cross-sectional, population-based, observational study, obtaining data from the 2019 Canadian Health Survey on Children and Youth between the ages of 12 and 17. Participants answered survey questions regarding sex assigned at birth, current gender identification, socioeconomic status based on annual household income, headache frequency, overt and relational bullying frequency, and suicidal ideation.

In the sample of 2,268,840 participants (mean age, 14.4), 48.8% identified as girls, 50.7% identified as boys, and 0.5% identified as gender diverse. A total of 11.2% of all participants reported frequent recurrent headaches.

Factors correlating with frequent recurrent headaches included older age (odds ratio [OR], 1.26; 95% CI, 1.20-1.31), female sex (OR, 2.89; 95% CI, 2.47-3.37), and gender diversity (OR, 3.30; 95% CI, 1.64-6.63). Compared with peers without frequent recurrent headaches, adolescents reporting frequent headaches were also more likely to experience bullying that was either overt (OR, 2.69; 95% CI, 2.31-3.14) or relational (OR, 3.03; 95% CI, 2.58-3.54).

After adjusting for age and sex, the researchers found that frequency of headaches were correlated with overt (adjusted OR, 1.82; 95% CI, 1.41-2.34) and relational (aOR, 1.54; 95% CI, 1.17-2.03) bullying but were not correlated with gender diversity alone (OR, 1.53; 95% CI, 0.69-3.69). The researchers suggest that the psychosocial factors associated with gender diversity may explain this discrepancy.

Other psychological factors that correlated with increased headache recurrence included suicidal ideations (aOR, 1.83; 95% CI, 1.44-2.32) and diagnosis with either an anxiety disorder (aOR, 1.74; 95% CI, 1.24-2.45) or a mood disorder (aOR, 1.50; 95% CI, 1.01-2.21). After adjusting for mood and anxiety disorders along with sex and age, the researchers found that suicidal ideation increased with headache frequency.

Study limitations included the cross-sectional design, lack of temporality preventing conclusions on causality, lack of generalizability to understudied populations, the risk for measurement bias due to retrospective self-report, and unmeasured confounding variables, such as genetics or secondary headache causes. Additionally, the large sample size and lack of a priori sample size calculations may lead to clinically insignificant findings.

“Peer victimization and suicidality may be associated with higher headache frequency in adolescents with headaches, independently of mood and anxiety symptoms,” the researchers wrote. “Gender diverse adolescents may have a higher risk of experiencing frequent headaches as compared to cisgender peers…explained by associated psychosocial factors.”

Disclosures: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Nilles C, Williams JV, Patten S, Pringsheim T, Orr SL. Association between peer victimization, gender diversity, mental health, and recurrent headaches in adolescents: a Canadian population-based study. Neurology. Published online August 2, 2023. doi:10.1212/WNL.0000000000207738