The 6 Pillars of Lifestyle Medicine and Headache Disability in Brazil: A Cross-sectional, Population-Based Study

Background Several lifestyle factors have been independently associated with headache disorders; however, less is known on the aggregated impact of lifestyle factors on headache disability. We aimed to explore the relationship between a healthy lifestyle score based on the six pillars of lifestyle medicine and prevalence of headache disability in Brazil. Methods Data were derived from the 2019 Brazilian National Health Survey, a nationwide, cross-sectional study. Prevalence estimates for disease-related disability were based on days missed from work, school, domestic chores, or recreation due to disease or health condition in the past 2 weeks. A healthy lifestyle score (0–14 points) incorporated self-reported data on physical activity, diet, sleep, mental health, risky substance use, and social connections. Weighted Poisson regression models with robust variance assessed the relationship between the healthy lifestyle scores and prevalence of headache-specific disability. Models were adjusted for age, sex, and socioeconomic and geographic disparities. The results are presented as prevalence ratio (PR) and 95% confidence intervals (95% CI). Results Among 88,531 adults included in the analysis (mean age 47.1 years; 52.9% female), 8,693 participants [weighted point prevalence = 8.8% (8.2%-9.2%)] reported disease-related disability. Headache-specific disability showed a weighted prevalence of 5.3% (4.6%-6.0%), the fifth most prevalent disease-related disability among Brazilian adults. The headache-specific disability group had a lower healthy lifestyle score than the no disability group [mean (SD): 7.8 (2.4) vs. 8.8 (2.4), p < 0.001]. Compared to participants who reported no disability over the past 2 weeks, the adjusted models revealed a significant inverse linear association between healthy lifestyle scores and the prevalence of headache-specific disability [PR = 0.85 (95% CI: 0.81, 0.89), p for linear trend: < 0.001]. Conclusions The adherence to the six pillars of lifestyle medicine is associated with lower prevalence of headache-specific disability in Brazil, supporting the adoption of lifestyle medicine approach in clinical practice as a strategy to reduce headache burden.