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We report the ORs for the association between risk factor and headache. If no interaction effect became significant, a single OR was reported, if any interaction term became significant, separate ORs for subgroups are displayed in Table 4. Out of the 38 bivariate associations that were tested, three reached significance: "Father had chronic pain" in women, "neglect" in men and "mother had mental disorder" in men Table 3. All were larger than one indicating that they constitute risk factors rather than protective factors. In the adjusted analysis ordered regression , no significant interactions were found between any of the risk factors and country or age.
However, there were significant main effects and two interactions with gender. Hence, Table 4 shows only the interaction terms for gender, but ORs are controlled for the main effects of gender and age. Generally, not many risk factors for headaches were identified. Most ORs were larger than one, but still small and insignificant. There were three exceptions. Neglect constituted a strong risk factor with an OR of 2. Because it was larger than our criterion alpha, it was not regarded. However, one could plausibly argue that the value was close to the nominal significance level and it would be incorrect to ignore it, particularly since it is known that the statistical power to detect interactions is usually low.
Therefore, we examined it. The adjusted OR for women was 3. Averaging over the two does not do much harm in this case. A second significant result was that paternal chronic pain was associated with more headaches in women, but not in men. Therefore, we examined it as well. The adjusted OR was 1. It showed a significant interaction with gender, too.
The significant bivariate effect for "mother having any mental problems" in men did not remain significant after adjusting for confounders. To explore if the 16 childhood adversities which did not display any significant effect on headaches individually may do so if analyzed cumulatively, an unweigted sum score was calculated over the 16 risk factors. The score had a Cronbachs alpha of. In sum, the present results indicate that for adult headaches, childhood adversities do not constitute strong risk factors.
A total of 16 out of the 19 factors explored here showed non-significant associations as well as their sum score. Naturally, this is at least partly a consequence of the low significance level that was chosen. However, we set it low intentionally to avoid spurious results, considering that six statistical tests per risk factor sum up to tests in total.
On the other hand, such a lack of significant associations was surprising, because it partly stands against the results from other studies examining adult headaches and childhood adversities e. We did not put much weight to the result regarding the cumulative score of the 16 individually non-significant risk factors due to two reasons: 1 It was non-significant even if close to the boarder. However, the three individual risk factors that were identified deserve attention. The most interesting result was the one for neglect.
It turned out to be a relatively strong risk factor for headache, both for women and men, in Poland as well as in Germany. Neglect is a risk factor that has been explored rarely in research, even though it is one of the most frequent childhood adversities identified by the child protection services [ 21 ]. Some studies explored neglect and found mostly smaller effects than for other childhood adversities. The present indicator for childhood neglect was a scale combined from five items for physical and five for emotional neglect and not a single item—Scott et al.
Perhaps this contributes to the higher effect size. The design of the present study does not allow to draw causal conclusions. It is clearly possible that the association between childhood neglect and adult headaches was generated by third variables, for example a certain answering style. Genetic effects were proven in the genesis of headaches [ 22 — 24 ], but it is hard to imagine that they may increase the risk for childhood neglect.
Frequency of child maltreatment in a representative sample of the German population
About the mechanism how childhood neglect may increase the risk for adult headache we can only speculate. There are results from mice showing that neglected pups display different pattern of methylation than well cared ones e. A more psychological view would be that a neglected child will probably realize at some age that her or his parents do not care as much as other parents do. But before such a realiziation, it may already develop feelings of being not worth to be loved, being guilty for something or even feels shame for the parents [ 26 ]. Such feelings would rather lead to a mechanism of internalizing negative emotions than to externalize them.
Internalizing anger and suppression of feelings were shown to be risk factors for headaches [ 27 , 28 ].
Childhood Adversities and Adult Headache in Poland and Germany
Poor ability to regulate negative emotions seems to generally be associated with chronic pain [ 29 ]. Other forms of abuse, e.
In this context, it would have been interesting to distinguish between physical and emotional neglect because we would rather expect the emotional neglect to be associated with headaches. However, we were not able to do so, even though we used standard questions like many other researches, too [ 17 ]. We think that more research would be necessary on childhood neglect as a risk factor for later mental and physical health.
The two interaction effects that were detected are more difficult to interpret. From the parents as a model hypothesis, it seems paradoxical that women from fathers with chronic pain have a higher risk of developing headaches in adulthood, but not men. A less pronounced but similar pattern was observed for men and maternal chronic pain.
Hence, a different mechanism may act as a mediator in this case. We explored the hypothesis that girls would have had to care for fathers with chronic pain, in the sense of insecure attachment or more specifically parentification [ 31 ]. Hence, we tested whether paternal parentification was a mediator between paternal chronic pain and headache in the sense of Baron and Kenny [ 32 ]. This was not the case. So, the explanation for the effect probably lies elsewhere. Before such an effect can be interpreted in detail, we want to repeat the analysis on a different data set.
Then, it would be possible to check whether offspring headache is associated with parental headache, while other pain locations in parents may possibly show different patterns. Similarly problematic to interpret is the second interaction. For boys, this was associated with a higher risk for headache, for girls with a slightly lower one. One could say that because both effects were non-significant against one, it would be superfluous to interpret it at all, but this would not be fair insofar as the difference between girls and boys was significant according to our alpha level.
There have been some comments in the literature that boys may be more sensitive than girls regarding various childhood adversities e. Most likely, boys and girls were taken out of their families for different reasons, but unfortunately this was not assessed in our questionnaire. If we repeat this research using a different sample, we would add an open field to this question requesting the reason for not growing up with biological parents. The present study has the following limitations. First, data were assessed retrospectively via an internet survey.
It is unknown how much of a selection bias or of a memory bias is present. There is an ongoing critique on how valid such data are e. Second, headaches were analyzed as a primary response. Since some of these may have a fluctuating course, complaints by subjects who currently feel well but who have had serious phases of impairment are left out. Third, headaches were assessed using only a single item.
There is no possibility to assess its reliability. Additionally, the answering categories may have had a different meaning for different subjects. Fourth, anxiety and depression were not considered, here, which both show associations to pain [ 39 ]. Fifth, ORs were chosen as an indicator for the relationships. It is known that ORs tend to overestimate associations under certain conditions [ 40 ]. Beside these limitations, the study has the advantage of relying on a relatively large sample from two different countries. The advantage of a multi-language survey is that in case of a congruence of effects, as was consistently the case in the present study, the likelihood that effects are mainly a result of the phrasing of the items decreases.
However, when lining up the present study alongside previous research, the magnitude of the associations estimated here would surely fall into the lower rank of estimating the strength of the influence of childhood adversities on adult headaches.