Article
VALENCIA, SPAIN—A history of childhood sexual abuse is nearly fourfold more common among patients with chronic migraine than in those with episodic migraine, according to research presented at the International Headache Congress. This association raises the possibility that prior sexual abuse is a contributing factor in the transformation from episodic migraine to chronic migraine, said Brad Torphy, MD, of Diamond Headache Clinic in Chicago.
Brad Torphy, MD
“The clinical implication of these findings, and what I’m stressing, is the importance of intervention—such as psychological counseling—in episodic migraine patients who have a history of abuse,” he said in an interview. “The other key point is that patients who have episodic migraine may warrant more aggressive therapy, including going on preventive medications sooner, if they have a history of sexual abuse, because they’re probably at risk for progression to chronic migraine.”
Dr. Torphy presented a retrospective study of all new patients seen at the Diamond Headache Clinic during the final four months of last year. The new-patient questionnaire includes a section about past sexual abuse. Such a history was reported by six (4.4%) of the 135 patients with episodic migraine, compared with 30 (15.5%) of the 194 patients with chronic migraine.
Based upon his experience in the clinic, Dr. Torphy suspects that the true proportion of patients with a positive history for sexual abuse is considerably higher than the rates the new-patient questionnaire would suggest.
“A lot of factors would lead to that being a very low number,” Dr. Torphy continued. “It’s the patient’s first visit, and it’s a paper questionnaire, so patients may not be comfortable checking that box when they don’t know who’s going to see the results. I’ve had cases where patients shared with me only after two or three visits that, yes, I do have that history. I think it’s underreported across the board.”
In his review of the literature, he found that other investigators have tended either to lump together all kinds of abuse—physical, emotional, and sexual—in analyzing an association with migraine, or if they looked at sexual abuse in particular, it was in association with all types of chronic pain, not specifically migraine.
—Bruce Jancin