<b>Association between screen time and self-reported severe headache or migraine: </b><b>a nationwide population-based study</b>

AbstractBackground: Headache disorders are widely prevalent and impose a considerable economic burden on individuals and society. Recent studies have shown an association between screen time and self-reported headache or migraine in children and adolescents, but the association remains unclear among the adult population in the US.Methods: A cross-sectional analysis was conducted utilizing data from the 1999–2002 National Health and Nutrition Examination Survey (NHANES), including participants aged 20 to 85 years. Screen time was categorized into less than 4 hours per day (&lt;4 h/d) and 4 or more hours per day (≥4 h/d). Unweighted and survey-weighted multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between screen time and self-reported severe headache or migraine. Sensitivity analyses were performed including subgroup analyses, propensity score matching(PSM), multiple imputation for missing covariable data, and the calculation of E?values with 95% CIs.Results: Among 6,797 participants (3,468 males; 3,329 females), the prevalence of self-reported severe headache or migraine was 19.8% (1349/6797). Participants with ≥4 h/d of screen time had a modestly higher prevalence of self-reported severe headache or migraine than those with less screen time (p &lt; 0.05). After adjusting for confounders, the OR was 1.16 (95% CI: 1.01–1.34). Similar results were obtained in survey-weighted analyses, with ORs ranging from 1.23 to 1.27 (all p-values &lt; 0.05). The association remained stable in sensitivity analyses.Conclusions: Adults with ≥4 hours of daily screen time had a modestly increased prevalence of self-reported severe headache or migraine compared to those with shorter screen exposure. Given the use of self-reported measures and the cross-sectional design, causality cannot be inferred. These findings should be confirmed in longitudinal studies using validated headache assessments.Keywords: Screen time. Headache. Migraine. Television. Video games