Findings suggest abuse is a risk factor for chronic headache

Researchers from the American Headache Society's Women's Issues Section Research Consortium found that incidence of childhood maltreatment, especially emotional abuse and neglect, are prevalent in migraine patients. The study also found that migraineurs reporting childhood emotional or physical abuse and/or neglect had a significantly higher number of comorbid pain conditions compared with those without a history of maltreatment. Full findings of the study appear in the January 2010 issue of Headache: The Journal of Head and Face Pain, published on behalf of the American Headache Society by Wiley-Blackwell.

According to a report by the U.S. Department of Health and Human Services, state and local child protective services (CPS) investigated 3.2 million reports of child abuse or neglect in 2007. CPS classified 794,000 of these children as victims with 59% classified as child neglect; 4% were emotional abuse; 8% as sexual abuse; and 11% were physical abuse cases. Both population- and clinic-based studies, including the current study, have demonstrated an association between childhood maltreatment and an increased risk of migraine chronification years later.

To conduct this study, Gretchen E. Tietjen, M.D, from the University of Toledo Medical Center, and colleagues, recruited a cross-sectional survey of headache clinic patients with physician-diagnosed migraine at 11 outpatient headache centers. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ), a 28-item self-reported quantitative measure of childhood abuse (physical, sexual, and emotional) and neglect (physical and emotional). Self-reported physician-diagnosed history of comorbid pain conditions such as irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS), fibromyalgia (FM), interstitial cystitis (IC), and arthritis was recorded on the survey.

A total of 1348 patients diagnosed with migraine completed the surveys. Researchers found migraineurs who reported childhood emotional abuse or physical neglect had a significantly higher incidence of comorbid pain conditions compared with those without a history of maltreatment. In the study population, 61% had at least 1 comorbid pain condition and 58% reported experiencing childhood trauma either by abuse or neglect. The number of different maltreatment types suffered in childhood correlated with the number of comorbid pain in adulthood.

Specifically, physical abuse was associated with a higher incidence of arthritis; emotional abuse was linked to a greater occurrence of IBS, CFS, FM, and arthritis; and physical neglect connected with more reports of IBS, CFS, IC, and arthritis. In women, physical abuse and physical neglect was associated with endometriosis (EM) and uterine fibroids, emotional abuse with EM, and emotional neglect with uterine fibroids.

"Our study found that while childhood maltreatment is associated with depression, the child abuse-adult pain relationship is not fully mediated by depression," explained Dr. Tietjen. Results from this study, as well as three recent population-based studies, indicate that associations of maltreatment and pain were independent of depression and anxiety, both of which are highly prevalent in this population.

Researchers suggest that for persons presenting for migraine treatment, childhood maltreatment may be an important risk factor for development of comorbid pain disorders. "Since migraine onset preceded onset of the comorbid pain conditions in our population, treatment strategies such as cognitive behavioral therapy may be particularly well suited in these cases," concluded Dr. Tietjen.