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A new study published in the Journal of Neurology looked at the association between peer victimization, gender diversity, mental health, and recurrent headaches in adolescents.

“In this study, we wanted to try and understand if bullying and being gender diverse are associated with frequent headaches in teens,” study author Serena L. Orr told us. “Although some past studies have looked at the relationship between bullying and headaches, they have not adequately controlled for other risk factors associated with both of these, including mental health, age, and sex. To our knowledge, no past studies have looked at whether gender diverse teens are at higher risk of frequent headaches.”

Chronic pain, including recurring headaches, has been defined by the International Association for the Study of Pain as a biopsychosocial condition. The researchers expected that both bullying and being gender diverse would be associated with frequent headaches in teens, even after accounting for factors associated with both including mental health.

“Not only is biology important in understanding headaches, but so are psychosocial factors,” Orr told us. “In our lab, we are particularly interested in psychosocial factors associated with headaches in youth. We are interested in these because we can act on them with improved social, health, and public health policies.”

The team used survey data from Statistics Canada to look at the relationship self-reported frequent headaches, and bullying as well as gender diversity, in a weighted sample of over two million Canadian teens. They looked at whether these were associated with frequent headaches, using simple models that also included age and sex, and also in larger models, where we also accounted for included other important factors like socioeconomic status, anxiety, depression, and suicidality.

“We found that bullying and being gender diverse were both associated with frequent headaches in teens, even when accounting for the effects of sex and age,” Orr told us. “In our larger models, where we also accounted for socioeconomic status, anxiety, depression, and suicidality, the effect of being gender diverse was no longer significant, but bullying was. We expect that this may be because mental health and bullying account for the initial relationship seen between frequent headaches and being gender diverse. In addition to this, we found that teens with frequent headaches were also more likely to report suicidality, and the more headaches they had, the more likely they were to have a history of suicidality.”

The team was surprised at the strong and consistent relationship between frequent headaches and bullying and suicidality in teens. They were also surprised that being gender diverse in and of itself was not associated with frequent headaches after accounting for the other factors.

“These results highlight the importance of anti-bullying policies, given the impact bullying is known to have on mental health and here we also show an impact on physical health (i.e., headaches),” Orr told us. “They should also alert clinicians to the importance of screening teens with frequent headaches for bullying, mental health symptoms, and suicidality. Parents of teens experiencing frequent headaches may also want to talk to their teens about mental health, bullying, and suicidality and seek help if there are concerns.”