Regular Smoking, Drinking Linked to Headaches in Teenagers CME

From MedscapeCME Clinical Briefs
News Author: Pauline Anderson
CME Author: Charles P. Vega, MD

Headache. Published online June 7, 2010.


Clinical Context

Somatic complaints are common among adolescent girls, according to a study by Ghandour and colleagues, which appeared in the August 2004 issue of Archives of Pediatric & Adolescent Medicine. In a survey of 8250 adolescent girls across the United States, researchers found that the prevalence rates of stomach ache and back pain occurring more than once a week each exceeded 20%. A total of 30.6% of girls reported regular symptoms of morning fatigue, and 29.1% experienced headaches more than once a week. Multiple somatic symptoms also tended to cluster in the same individual.

Lifestyle factors have been linked to a higher risk for headaches among adults, but there is less information on this potential relationship among children and adolescents. The current study addresses this issue.


Study Highlights

The study was completed at 11 public schools in Germany. Researchers focused on students in the 10th and 11th grades (aged between 14 and 20 years).
Study participants completed a questionnaire regarding headache and lifestyle factors. Adolescents who reported headache in the last 6 months were asked to provide more data about the headache, which were then used to give them a provisional headache diagnosis.
The main study outcome was the relationship between lifestyle factors and the prevalence of headache. Lifestyle factors included diet, exercise, smoking, and alcohol consumption. The study analysis was adjusted to account for age, sex, and socioeconomic status.
1260 adolescents provided study data. Many participants had a poor diet: 28.4% never had breakfast, and only 13.3% ate 3 to 5 servings of fruit and vegetables per day.
Nearly one quarter of the study cohort smoked cigarettes, and 56.6% of respondents drank coffee. Alcohol use was also widespread.
83.1% of participants reported headache in the last 6 months. 48.7% of participants had TTH, and 10.2% had migraine headache. The remainder of the headaches was mixed type or not classified.
Drinking cocktails at least once a week, drinking at least 1 cup of coffee per day, and low levels of physical activity were all associated with an adjusted OR of 2.0 for headache.
The OR for migraine among adolescents who reported drinking at least 1 cup of coffee per day was 3.4, and the respective OR among students who were less physically active was 4.2.
TTH was most associated with being less physically active (OR, 1.7).
Smoking was less associated with the risk for headache, and skipping breakfast had no correlation with headache. Consuming beer and fruit and vegetable consumption were also not significantly associated with the prevalence of headache.

Clinical Implications

A previous survey of adolescent girls in the United States found high rates of stomachache, back pain, morning fatigue, and headache. Symptoms tended to cluster in individual adolescents.
The current study demonstrates a correlation between headaches among adolescents and drinking cocktails, low levels of physical activity, and coffee consumption. Low levels of fruit and vegetable consumption, skipping breakfast, and drinking beer were not significantly associated with the prevalence of headache.