Association between Headache and Frailty among Middle-aged and Elderly Individuals: Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

Background: Frailty, a clinically recognized geriatric syndrome marked by diminished physiological reserve and heightened vulnerability to adverse health outcomes stemming from multisystem dysregulation, represents a growing global health challenge. This investigation sought to examine the potential association between cephalalgia and incident frailty risk in aging populations. Methods: Leveraging longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) across 2011-2015 waves, we performed both cross-sectional and prospective cohort analyses involving 17,705 community-dwelling adults aged ≥45 years. Episodic headache was defined as reporting headache either at baseline (2011, Wave 1) or at the follow-up (2015, Wave 3).Chronic headache was defined as reporting headache at both baseline (2011, Wave 1) and at the follow-up endpoint (2015, Wave 3).. Frailty status was quantified using a validated 32-item frailty index (FI) encompassing functional, cognitive, and comorbid conditions. Results: At Wave 1, significant differences were observed between the headache group (n = 1,416) and non-headache group (n = 10,314). The headache group had a higher proportion of females (67.4% vs. 47.4%) and a higher prevalence of comorbidities, including frailty (30.2% vs. 7.8%). They also reported lower engagement in hobbies, smoking, and drinking, as well as shorter sleep duration (5.7 ± 2.1 vs. 6.5 ± 1.7 hours) (all P < 0.001). Logistic regression analysis indicated significantly higher odds of frailty for the headache group in the unadjusted model (OR 5.13, 95% CI 4.48–5.87) and after adjusting for sociodemographic factors (OR 5.39, 95% CI 4.60–6.32) and lifestyle factors (OR 4.22, 95% CI 3.52–5.06) (all P < 0.001). At Wave 3, individuals with chronic headache had markedly elevated odds of frailty (OR 8.30, 95% CI 5.91–11.66) compared to episodic headache (OR 3.71, 95% CI 3.04–4.53). Both chronic (OR 7.98, 95% CI 5.18–12.28) and episodic headaches (OR 3.49, 95% CI 2.73–4.45) remained significantly associated with frailty after adjustments. Subgroup analyses confirmed consistent associations across various demographics, including age and marital status (all P < 0.001). No significant interactions were noted across subgroups. Conclusion: Our study demonstrates that headache is significantly associated with an increased risk of frailty in middle-aged and older adults, with chronic headache showing a more pronounced effect. These results underscore the clinical imperative for optimized headache management strategies as a potential modifiable factor in frailty prevention. Implementing such strategies may concurrently improve geriatric quality of life and reduce the socioeconomic burdens linked to aging-related disability.