VANCOUVER—Childhood emotional abuse may be associated with migraine in adulthood, according to data presented at the 68th Annual Meeting of the American Academy of Neurology. The research indicates that emotional abuse during childhood has a more significant effect on migraine, compared with physical and sexual abuse.
Childhood maltreatment, which includes neglect and abuse (ie, emotional, physical, and sexual), is confirmed in 12.5% of children by the age of 18, according to a report published in 2014 in JAMA Pediatrics. Previous studies have linked childhood abuse to headache, but there has been limited assessment of other major types of abuse. “In 2015, there were six different meta-analyses from all over the world linking childhood emotional abuse in particular with adult psychiatric disease,” said Gretchen Tietjen, MD, Professor and Chair of Neurology at the University of Toledo in Ohio.
Gretchen Tietjen, MD
Dr. Tietjen and her colleagues conducted a study to better understand the association between emotional abuse and migraine, independent of depression and anxiety. The study’s objectives were to examine the correlation between migraine and the number of types of abuse and frequency of abuse, and to examine the influence of sex and race on migraine. They also strove to determine the temporal relationship between age of onset of abuse, depression, and anxiety and age of onset of migraine.
There were 14,484 participants aged 24 to 32 in the study. About 14% of participants self-reported that they had been diagnosed with migraine. Fifteen percent of the population reported a diagnosis of depression (35% in the migraine sample vs 12% of controls), and 12% of the sample reported a diagnosis of anxiety (25% in the migraine sample vs 10% of controls). The mean age in the study was 29.5. Fifty-three percent of participants were women and 36% of the population was nonwhite.
All participants filled out a “Mistreatment by Adults” questionnaire about experiences before age 18. Emotional abuse was assessed by asking participants how often a parent or other adult caregiver had said things that hurt their feelings or made them feel unwanted or unloved. Physical abuse was assessed by asking whether a parent or caregiver had hit the participant with a fist, kicked him or her, or threw him or her to the floor, into a wall, or down stairs. And finally, sexual abuse was assessed by asking whether a parent or adult caregiver had touched the participant in a sexual way, forced him or her to touch him or her in a sexual way, or forced him or her to have sexual relations. The dependent variable in the study was self-reported doctor diagnosis of migraine. Sociodemographic characteristics recorded included age, sex, household income, and race. Self-reported physician diagnoses of depression and anxiety were examined as additional confounders.
Abuse was recalled by 60.5% of participants with migraine and 49% of the nonmigraine sample. Abuse increased the chance of migraine diagnosis by 55%. Emotional abuse had the strongest link to migraine, and the link was stronger in males than in females. When the researchers controlled the data for depression and anxiety, the effect of child abuse on migraine was attenuated, but remained significant. In addition, the effect of emotional abuse on migraine decreased, but remained significant when the investigators controlled for depression and anxiety. The researchers found no association between physical and sexual abuse when they adjusted for other abuse types, and there was no association with any abuse type and migraine in the non-Caucasian cohort.
Strengths of this study included its nationally representative population-based sample, its population’s relatively young mean age of 30 (which was 20–30 years younger than populations in other studies), and the inclusion of questions on three major types of abuse. Limitations of the study included its reliance on self-reported, retrospective data on abuse and on physician-diagnosed conditions; its broad definition of emotional abuse; and its potential for recall bias and reporting bias.
The next goal for this investigation is to determine the neurophysiologic mechanisms of the relationship between migraine and emotional abuse, said Dr. Tietjen. The relationship itself needs to be confirmed. “We’re currently looking at the database for gene–environment interactions that may link abuse to migraine for persons with a specific genotype. There’s also an opportunity for investigation of other different kinds of modifications that we know occur with abuse and whether these play a role in determining migraine,” she concluded.
—Erica Robinson
