Objective: Leadership styles can influence subordinates’ health. We investigated how the gene encoding the Catechol-O-Methyltransferase (COMT) enzyme (ie, COMT rs4680 Val158Met) influenced effects of abusive supervision and transformational leadership on subordinates’ headache and neck pain. Methods: Multiple group structural equation modeling (SEM) was employed to test associations of leadership with subordinates’ pain 6 months after in a representative sample of the Norwegian working population (n = 996). Genotyping was performed by TaqMan technology. Results: Abusive supervision was associated with increased risk, and transformational leadership with decreased risk, of headache and neck pain. Both leadership styles exhibited more pronounced effects in individuals with the Met/Met genotype. Conclusion: Met/Met employees were relatively vulnerable to adversity, but also relatively responsive to constructive leadership. Many workers may benefit more from constructive leadership than population-averaged associations might suggest.