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Circadian syndrome and headache accompanied by stomach pain among middle-aged and older Chinese adults: associations and the mediating role of frailty
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DOI：10.1186/s10194-026-02491-z.png)
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Abstract
En 中文
Circadian syndrome (CircS) integrates metabolic abnormalities, short sleep duration, and depressive symptoms, and may reflect multidimensional circadian-related health dysregulation. Migraine is a disabling neurological disorder that is frequently accompanied by gastrointestinal symptoms, but evidence on the association between CircS and migraine-related symptom phenotypes in middle-aged and older adults remains limited. This study examined the associations between CircS and headache accompanied by stomach pain, a self-reported symptom co-occurrence phenotype, and explored the mediating role of frailty. Data were obtained from the China Health and Retirement Longitudinal Study. A total of 9,342 participants were included in the cross-sectional analysis, and 5,895 participants without headache accompanied by stomach pain at baseline were included in the longitudinal analysis. CircS was defined as the presence of at least four of seven components. Logistic regression and Cox proportional hazards models were used to examine the associations of CircS with prevalent and incident headache accompanied by stomach pain, respectively. Sensitivity analyses included complete-case analyses, a 2-year lag analysis, age-restricted analysis, propensity score matching, and E-value analysis. Time-dependent receiver operating characteristic curves and bootstrap mediation analysis were also performed. CircS was associated with higher odds of prevalent headache accompanied by stomach pain after full adjustment (OR = 1.38, 95% CI: 1.14–1.67, p < 0.001). During follow-up, 969 participants developed incident headache accompanied by stomach pain. CircS was associated with an increased risk of incident headache accompanied by stomach pain (HR = 1.33, 95% CI: 1.16–1.51), and the risk increased with greater CircS component burden. Sensitivity analyses generally supported the main findings. CircS showed numerically higher discriminative ability than metabolic syndrome and individual CircS components. Frailty explained 19.72% of the association between CircS and incident headache accompanied by stomach pain (p < 0.001). Among middle-aged and older Chinese adults, CircS was associated with prevalent and incident headache accompanied by stomach pain, and frailty partially explained this association. As the outcome was based on self-reported symptom co-occurrence, it should not be equated with clinically diagnosed migraine.
Keywords:
Circadian syndrome
Headache accompanied by stomach pain
Frailty
Middle-aged and older adults
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