Exposure to interpersonal violence seems to constitute an important etiological
factor. Thus, knowledge of the multiple pathways linking interpersonal violence
to recurrent headache could help guide preventive and clinical interventions. In
the present study we explored a hypothetical causal model where the link between
exposure to interpersonal violence and recurrent headache is mediated in
parallel through loneliness and psychological distress. Higher level of family
cohesion and male sex is hypothesized to buffer the adverse effect of exposure
to interpersonal violence on headache.
The model was assessed using data from the
cross-sectional, population-based Young-HUNT 3 study of Norwegian adolescents,
conducted from 2006–2008. A cohort of 10 464 adolescents were invited. The
response rate was 73% (7620), age ranged from 12 and 20 years, and 50% (3832)
were girls. The study comprised self-report measures of exposure to
interpersonal violence, loneliness, psychological distress and family cohesion,
in addition to a validated interview on headache, meeting the International
Classification of Headache Disorders criteria. Recurrent headache was defined as
headache recurring at least monthly during the past year, and sub-classified
into monthly and weekly headache, which served as separate outcomes.
In Conditional Process Analysis, loneliness and
psychological distress consistently posed as parallel mediating mechanisms,
indirectly linking exposure to interpersonal violence to recurrent headache. We
found no substantial moderating effect of family cohesion or sex.
Loneliness and psychological distress seem to play
crucial roles in the relationship between exposure to interpersonal violence and
recurrent headache. To facilitate coping and recovery, it may be helpful to
account for these factors in preventive and clinical interventions.
Trauma-informed, social relationship-based interventions may represent a major
opportunity to alter trajectories of recurrent headache.
Interpersonal violence; Sexual abuse; Bullying;
Loneliness; Social isolation; Psychological distress; Family cohesion; Social
support; Recurrent headache