INTEGRATED BIOLOGICAL PROFILES MODULATE ATTACHMENT-RELATED AUTONOMIC REGULATION IN ADOLESCENT PRIMARY HEADACHE

Recent evidence suggests that dysfunctional attachment relationships with parents may be associated with vagal dysregulation, although the underlying biological mechanisms remain poorly understood. In this context, primary headache (PH) during adolescence represents a neuropsychosomatic condition characterized by heightened sensitivity to relational stress, somatization and autonomic dysregulation. The present study investigated the biological mechanisms involved in the association between attachment toward caregivers, vagal regulation, and somatic symptoms in adolescents with PH.
Eighty-four adolescents with a diagnosis of PH were assessed for somatic symptoms using the Children’s Somatization Inventory and for attachment to parents using the Experiences in Close Relationships questionnaire. Vagally-mediated heart rate variability was recorded at baseline and during an activating, attachment-related task. We analyzed blood-based markers (CRP, fibrinogen, WBC, thyroid hormones, prothrombin time) using Exploratory Factor Analysis (EFA), deriving integrated biological dimensions. Moderation models tested whether these dimensions influenced the links between attachment, somatic symptoms, and vagal regulation.
EFA identified two distinct factors: inflammatory/immune and endocrine/hemostatic. Both factors significantly moderated the relationship between avoidant attachment and somatic symptoms. However, only the endocrine/hemostatic profile moderated the association between avoidant attachment to the father and vagal reactivity during the emotional task.
Overall, these findings support a context-dependent model of vagal regulation in adolescence, in which attachment-related autonomic responses emerge under emotional challenge and are shaped by specific biological profiles. This study highlights the complexity of biobehavioral interactions in pediatric headache and underscores the importance of a multimodal approach in this topic.