Association between waist-to-height ratio and headache symptoms in U.S. youth: A nationwide cross-sectional study

To examine the association between waist-to-height ratio (WHtR), a marker of central adiposity, and the odds of frequent or severe headaches, including migraines, in U.S. children and adolescents. We analyzed 8915 participants aged 8-19 years in the 1999-2004 National Health and Nutrition Examination Survey (NHANES). WHtR was calculated as waist circumference divided by height and scaled by 10 to reflect the effect of a 0.1-unit increase. We applied survey-weighted logistic regression models to estimate associations between WHtR and self-reported headache status, adjusting for demographic, metabolic, and behavioral covariates. Additional interaction and sensitivity analyses were conducted to assess effect modification and robustness. Each 0.1-unit increase in WHtR was associated with a 26 % higher odds of reporting headaches (OR = 1.26, 95 % CI: 1.15, 1.38; p < 0.001). Compared to the lowest quartile (Q1), participants in the highest quartile (Q4) had 34 % greater odds (OR = 1.34, 95 % CI: 1.06, 1.70). Restricted cubic spline models demonstrated a linear dose-response association (p for nonlinearity = 0.96). The association remained robust across multiple sensitivity analyses. WHtR was linearly associated with the odds of frequent or severe headaches in U.S. youth. Although the cross-sectional design limits causal inference, WHtR may serve as a simple and developmentally stable marker for identifying obesity-related neurological symptoms, warranting further longitudinal investigation.