Childhood Abuse & Migraine Headaches - various

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Childhood Abuse & Mirgraine Headachesby Will Meek

September 27, 2007

 

Recent research is showing that people who struggle with migraine headaches

and depression often have a history of abuse from childhood. The idea is that

somehow the abuse “primes” the brain for migraine, meaning that people are more

susceptible to them later as adults.

Her recent study published in the journal Neurology, reported that women

with migraine and major depression were twice as likely to report childhood

abuse as migraineurs without depression. The study reviewed the survey responses

of 949 patients in six headache clinics around the country, including one at the

University of Toledo.

 

If the abuse continued after age 12, the risk of migraine and depression was

five times greater.

Clinically speaking, many mental health professionals think of migraine as

part of a larger mood or anxiety disorder. Headaches generally can be physical

symptoms of stress, with migraine being obviously a much more intense and severe

problem.

 

http://psychcentral.com/blog/archives/2007/09/27/childhood-abuse-mirgraine-heada\

ches/

 

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Abuse in childhood linked to adults' migraines: UT researcher also finds

connection to depression The Blade, Toledo, Ohio - September 17, 2007

 

Sep. 17--A history of child abuse may help lay down the tracks for later

migraine and depression.

 

Two recent studies led by Dr. Gretchen Tietjen, a neurologist at the former

Medical College of Ohio, uncover a connection between childhood abuse and adults

who suffer migraine with depression.

 

The research arose from what Dr. Tietjen noticed in her care of migraine

patients at the University of Toledo Health Science campus.

 

" Many of these people report having been in abusive relationships. They were

abused children, or came from unstable homes, or some are currently in an

abusive relationship,' she said.

 

Her research suggests that childhood abuse " primes the brain for pain' in

migraine. This could mark a genetic vulnerability where abuse triggers migraine

with depression among people with a particular versions of genes.

Studies have shown that some genes make people more susceptible to depression

in the wake of childhood trauma, she said.

 

Her recent study published in the journal Neurology, reported that women with

migraine and major depression were twice as likely to report childhood abuse as

migraineurs without depression. The study reviewed the survey responses of 949

patients in six headache clinics around the country, including one at the

University of Toledo.

 

If the abuse continued after age 12, the risk of migraine and depression was

five times greater.

 

" So many people are affected by not just migraine, but by a number of other

conditions that really seem to complicate the treatment, " Dr. Tietjen said. A

study she co-authored, published earlier this year, showed a strong link between

people with disabling migraine, depression, and the presence of back pain,

nausea, and stomach pain.

 

The current Neurology paper goes on to show that depressed people with

migraine were also twice as likely to say they witnessed abusive behavior and/or

substance abuse in their home when they were growing up.

 

" This may be the first paper that shows the incidence of abuse in chronic

migraine,' said Dawn C. Buse, Director of Psychology at the Montefiore Headache

Center, part of the hospital for the Albert Einstein College of Medicine in New

York.

 

It aligns with other research showing a link between abuse and pain disorders,

she said.

 

Dr. Peter Goadsby, of the University of California, San Francisco, said

headache and depression " share a biochemistry,' which is why they tend to come

up together.

 

" In context with this biological association..it's not entirely surprising' to

see the link between both and child abuse. " I think it's a useful observation. "

Not all migraine sufferers had the same constellation of symptoms, or the same

complications. Another recent study by Dr. Tietjen, published in the journal

Headache, showed migraineurs tended to fall into three general categories.

 

Researchers reviewed the medical charts of 223 migraine patients, uncovering

that about a quarter of the patients also suffered from high blood pressure,

high cholesterol, diabetes, or underactive thyroid. These patients tended to be

older, with an average age of 55. There were also more males, 22 percent, in

this group.

 

Some 38 percent of the patients, about 85 patients, had no other medical or

emotional complications. This group had an average age of 32, its first headache

at an average age of 18, and was 12 percent male.

 

About 37 percent of the patients -- some 83 people -- were characterized by a

higher incidence of depression, anxiety, and fibromyalgia. This group was

predominantly female -- only 5 percent were male -- had the lowest quality of

life of all the migraine sufferers, and were about 2.5 times more likely to

report past physical or sexual abuse, and 4 times more likely to report past

emotional abuse than other migraine sufferers.

 

Dr. Tietjen notes that there is a great deal of research to show that people

with migraine often must cope with depression. Some 10 percent of the population

suffers from migraine, and about 4 percent of the U.S population reports

migraine 15 times a month or more.

 

Just as not everyone with migraine has a history of abuse, not everyone with a

history of abuse suffers from migraine with depression. Dr. Tietjen says. The

difference may be genetic.

 

" Certain people that have a certain genetic makeup are sort of susceptible to

developing migraine and depression if they have life trauma. I think that the

earlier in life the abuse occurs, the more likely it is going to have an

impact,' she said.

 

In fact, she says, brain imaging studies have shown that abuse causes

long-term changes in brain structures.

 

Her research group is looking at genes that might be active in the

abuse/migraine/depression pathway. At the moment, they are looking at two genes,

including one involved in the brain neurotransmitter serotonin, known as 5-HTT.

A study in the journal Science in 2003 showed that stressful experiences led to

depression in people with one version of a serotonin transporter gene. The brain

chemical serotonin is associated with mood. Dr. Tietjen hopes to find funding to

look at five or six different genes.

 

Ms. Buse said research on migraine and depression and patient life history can

guide doctors who treat migraine patients to attend to " how the disease is

effecting the patients life, not just how is your medicine working, but how is

your quality of life, asking about ...work, family, mood. These are the things

we want clinicians to think about that should inform treatment. "

 

Dr. Tietjen, has published more than 20 research papers on migraine since

1991. Seven of those papers came out this year.

 

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http://www.psycport.com/showArticle.cfm?xmlFile=knightridder%5F2007%5F09%5F17%5F\

%5F0000%2D1756%2DTO%2DAbuse%2Din%2Dchildhood%2Dlinked%2Dto%2Dadults%2Dmigraines%\

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Childhood Abuse Linked to Migraine With Major Depression CME News Author:

Caroline Cassels

CME Author: Charles Vega, MD

Disclosures

Release September 7, 2007; Valid for credit through September 7, 2008

Credits Available

Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for

physicians;

Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians

 

 

September 7, 2007 — Research suggests childhood abuse may predispose women to

a potentially debilitating combination of migraine accompanied by major

depression.

 

Investigators at the University of Toledo–Health Science Campus found women

with migraine who had major depression were twice as likely as those with

migraine alone to report having been sexually abused as a child. Furthermore, if

the abuse continued past the age of 12 years, women with migraine were 5 times

more likely to report depression.

 

" When sexual abuse carries over into adulthood that is when it is most

strongly associated with the migraine/depression complex, " principal

investigator Gretchen Tietjen, MD, told Medscape.

 

" Our findings contribute to the mounting data showing abuse in childhood has a

powerful effect on adult health disorders and the effect intensifies when abuse

lasts a long time or continues into adulthood, " she said.

 

The study is published in the September 4 issue of Neurology.

Impact on Physical Health The findings also support research suggesting

sexual abuse may have a greater impact on health than physical abuse and that

childhood sexual abuse victims in particular are more likely to be adversely

affected.

 

While many studies have reported an association between headache and a history

of abuse, this is the first to use defined criteria for migraine and address the

effect of depression on the migraine-abuse relationship.

 

The multicenter, cross-sectional pilot study included 949 headache patients

attending 1 of 6 US specialty headache clinics between June 2003 and December

2004.

 

Potential study candidates included women aged 18 years or older with primary

headache disorder as defined by the International Classification of Headache

Disorders (ICHD-II) criteria. Eligible patients were asked to complete a

self-administered electronic questionnaire.

 

Patients were asked about physical, sexual, and emotional abuse and the age it

occurred. The questionnaire also included a headache-related disability scale.

Furthermore, patients were also screened for depression using the Personal

Health Questionnaire 9 (PHQ-9). Women were also screened for type and severity

of current somatic symptoms using the PHQ-15.

Age-Dependent Association The average monthly headache frequency for the

previous 3 months was also recorded. Patients were then divided into 2 groups:

those with 15 or more headaches per month and those with fewer than 15 headaches

per month.

Physical or sexual abuse was reported in 38% of the study population, with 12%

of women reporting they had experienced both. In addition, 21% reported being

hurt or frightened so badly they feared for their life.

Reports of physical and sexual abuse in childhood were 9% and 14%,

respectively.

 

According to the study, there was a significant overlap between maltreatment

types. For instance, among women who reported a history of sexual abuse in life,

45% also reported physical abuse and 43% reported fear for life related to

abuse.

 

This also held true with respect to childhood maltreatment types, with 19% of

the study population reporting childhood onset of all 3 types of abuse.

A total of 566 women had fewer than 15 headaches per month, and 383 had 15 or

more headaches per month. The investigators found a higher proportion of women

with a history of maltreatment types had chronic headache. In addition, a

history of maltreatment was significantly associated with depression severity.

 

Furthermore, migraineurs with major depression tended to have high somatic

symptom severity and were more likely to report past physical and sexual abuse

compared with their counterparts without major depression.

 

When investigators examined the association between current depression based

on age of onset, they found major depression was associated with childhood

sexual abuse and that the strength of this association doubled if the abuse

occurred both before and after the age of 12 years.

Depression Screen Worthwhile In the case of physical abuse, the association

with migraine plus major depression was strongest when the abuse occurred after

the age of 12 years. The authors speculate this could be the result of direct

trauma to the head and neck. However, they note, it is not possible to confirm

this hypothesis from the study data.

 

Although it is not clear how adverse life events trigger the

migraine/depression combination, there is some evidence suggesting it may be

moderated by a gene by environment interaction.

 

It is also possible, said Dr. Tietjen, that adverse childhood experiences may

alter neurobiologic systems that may predispose patients to a number of

disorders that includes migraine, fibromyalgia, irritable bowel syndrome, and

depression.

 

According to Dr. Tietjen, it may be worthwhile for clinicians who see patients

with migraine, particularly those with refractory headache, to administer a

depression screen.

 

" I find a lot of my patients who come to me complaining of migraine have also

previously been diagnosed with depression and are being treated with an

antidepressant. However, it is not until I apply a depression screen that I

realize that even though they've been on long-term antidepressant therapy, they

are still suffering from major depression, which suggests they are undertreated.

In such cases it may be worthwhile to put a greater emphasis on the psychiatric

aspects of their condition to see whether that mitigates their migraine, " she

said.

 

The study was supported by a grant from the American Headache Society to the

Women's Issue Section.

 

Neurology. 2007;69:959-968.

Clinical Context Maltreatment during childhood has been linked to an

increased risk for affective disorders in adulthood. In a retrospective cohort

study of 9460 adults by Chapman and colleagues, which was published in the

October 15, 2004, issue of the Journal of Affective Disorders, a history of

childhood emotional abuse increased the risk for lifetime depressive disorders,

with an adjusted odds ratio of 2.7. Moreover, an increasing severity of abuse

was associated with a linear increase in the risk for depression.

 

There is also a known relationship between migraine headache and depression,

with the presence of either disorder increasing the risk for the other. The

current study examines how a history of childhood maltreatment affects the

relationship between migraine and depression.

Study Highlights

Women aged 18 years or older attending 1 of 6 specialty headache clinics were

eligible for participation. Headache type was defined from criteria established

by the ICHD.

Participants received a questionnaire that inquired about their history of

physical and sexual abuse as well as a fear for their lives related to abuse.

They also completed assessments of headache severity. The PHQ-9 was used to

measure depression.

The main study outcome was the relationship between migraine headache,

depression, and a history of maltreatment.

1032 women participated in the study, and 92% were diagnosed with migraine

headache. The analysis focused only on subjects with migraine. The mean age was

42 years, and 25% of subjects had migraine along with another headache

diagnosis.

38% of subjects reported a history of physical or sexual abuse, and 12% of

participants reported a history of both physical and sexual abuse. Most cases of

abuse occurred during childhood, and there was significant overlap between

different types of abuse.

40% of women reported headaches on at least 15 days per month (chronic

headache), and nearly three quarters of the study cohort rated their headaches

as very severe. Approximately one third of the study group had depression and

significant somatization.

Women reporting physical abuse, sexual abuse, and fear for life related to

abuse had a higher rate of chronic headache. In addition, a history of

maltreatment was associated with more severe headache severity, higher levels of

depression, and more somatic symptoms.

Maltreatment did not affect the age of onset of headache. Women with a

history of witnessing abusive behavior between adults or substance abuse by

adults also had a higher risk for depression.

Compared with women without depression, women with migraine and major

depression were 4 times as likely to have a history of childhood maltreatment.

Women with migraine and less severe depression were twice as likely to have had

maltreatment in childhood.

In examining the timing of childhood maltreatment and the risk for

depression, sexual abuse prior to the age of 12 years was a particularly strong

risk factor. In addition, women with a history of sexual abuse both before and

after the age of 12 years had a 5-fold increase in the risk for major

depression.

The risk for depression also increased among participants who had had

multiple types of maltreatment vs a single category of abuse.

Pearls for Practice

Previous research has found a linear relationship between the severity of

childhood emotional abuse and the prevalence of depressive disorders in

adulthood.

The current study finds that a history of childhood maltreatment is common

among women with migraine headache. A history of maltreatment increases the risk

for depression among these patients.

 

http://www.medscape.com/viewarticle/562572

 

 

Source: American Academy of Neurology September 6,

2007 More on: Headaches, Headache Research, Mental Health Research,

Disorders and Syndromes, Children's Health, Mental Health

 

Depression In Women With Migraine Linked To Childhood Abuse Science Daily —

Childhood abuse is more common in women with migraine who suffer depression than

in women with migraine alone, according to a study published in the September 4,

2007, issue of Neurology®, the medical journal of the American Academy of

Neurology.

 

" This study confirms adverse experiences, particularly childhood abuse,

predispose women to health problems later in life, possibly by altering

neurobiological systems, " said study author Gretchen Tietjen, MD, with the

University of Toledo-Health Science Campus and a member of the American Academy

of Neurology.

 

Researchers surveyed 949 women with migraine about their history of abuse,

depression and headache characteristics. Forty percent of the women had chronic

headache, more than 15 headaches a month, and 72 percent reported very severe

headache-related disability. Physical or sexual abuse was reported in 38 percent

of the women and 12 percent reported both physical and sexual abuse in the past.

These results for abuse are similar to what's been reported in the general

population.

 

The association between migraine and depression is well established, but the

mechanism is uncertain. The study found women with migraine who had major

depression were twice as likely as those with migraine alone to report being

sexually abused as a child. If the abuse continued past age 12, the women with

migraine were five times more likely to report depression.

 

" The finding that a variety of somatic symptoms were also more common in

people with migraine who had a history of abuse suggests that childhood

maltreatment may lead to a spectrum of disorders, which have been linked to

serotonin dysfunction, " said Tietjen.

 

" Our findings contribute to the mounting data that show abuse in childhood has

a powerful effect on adult health disorders and the effect intensifies when

abuse lasts a long time or continues into adulthood, " said Tietjen. " The

findings also support research suggesting that sexual abuse may have more impact

on health than physical abuse and that childhood sexual abuse victims, in

particular, are more likely to be adversely affected. "

 

The study also found women with depression and migraine were twice as likely

to report multiple types of abuse as a child compared to those without

depression, including physical abuse, fear for life, and being in a home with an

adult who abused alcohol or drugs.

 

" Despite the high prevalence of abuse and the increased health costs

associated with it, few physicians routinely ask migraine patients about abuse

history, " said Tietjen. " By questioning women about their abuse history we'll be

able to better identify those women with migraine at increased risk for

depression. "

 

The study was supported by a grant from the American Headache Society.

 

Note: This story has been adapted from material provided by American Academy

of Neurology.

 

http://www.sciencedaily.com/releases/2007/09/070903204940.htm

 

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