Irregular meals, such as skipping breakfast, are linked to an increased risk of frequent headaches in children and adolescents, according to a new study published in the online issue of the American Academy of Neurology’s medical journal Neurology.

Frequent headaches are also associated with the use and exposure to electronic cigarettes for ages 12-17.

The study included nearly five million children and adolescents, ages 5-17, who participated in a large Canadian health survey. They were asked if they had experienced headaches in the previous six months and how often. In the study, frequent headaches were defined as occurring more than once a week. About 6% had headaches more than once a week.

They were also asked about various lifestyle factors such as screen time, sleep times and meals. Anxiety and mood disorders were assessed. Participants reported how many times in the past week they ate breakfast and how often they sat down to dinner with their family, for a total of 14 meals. It found that those who experienced frequent headaches had an average of nine such meals per week compared to an average of twelve meals for children who had one or no headaches per week.

After adjusting for factors such as age, gender and lifestyle factors, the researchers found that participants who regularly ate breakfast and dinner with their family had an 8% lower risk of frequent headaches than those who did not eat regular meals.

Participants aged 12-17 were also asked how often they used substances such as alcohol, cigarettes, e-cigarettes and cannabis. The researchers found that those who used e-cigarettes daily were twice as likely to have frequent headaches compared to those who never used e-cigarettes. In contrast, the researchers found no association of headaches with sleep, screen time, and use of other substances. In addition, participants with anxiety and mood disorders had twice the risk of frequent headaches compared to those without the disorders.