A Retrospective, Comparative Study on the Frequency of Abuse in Migraine and Chronic Daily Headache

B. Lee Peterlin, DO; Thomas Ward, MD; Jeffrey Lidicker, MSc; Morris Levin, MD


Headache. 2007;47(3):397-401. 

In This Article

Abstract and Introduction

Objective: To assess and contrast the relative frequency of a past history of physical and/or sexual abuse in patients with chronic daily headache (CDH) versus migraine.
Background: A number of risk factors have been identified as risk factors for chronification of headache disorders. Limited data exist regarding the influence of physical and/or sexual abuse on primary headache disorders.
Methods: This was a retrospective chart review of 183 consecutive new headache patients seen from December 2004 through August 2005 at an outpatient tertiary-care center. Patients were included in the study if they had chronic daily headache (with criteria for medication over-use headache or chronic migraine), or migraine with or without aura. A history of physical and/or sexual abuse was systematically asked of all headache patients at their first visit in the clinic. This information was then transferred to a semi-standardized form and the relative frequency of abuse in both groups contrasted.
Results: Of the 161 patients included in the study, 90.1% were female with a mean age of 36.4 ± 12.0. A total of 59.0% of the patients were diagnosed with CDH and 41.0% were diagnosed with migraine. Overall, 34.8% of all patients, 40.0% of CDH patients, and 27.3% of migraine patients had a history of physical and/or sexual abuse. The relative frequency of a history of physical and/or sexual abuse was higher in the CDH group as compared to the migraine group (P = .048).
Conclusion: The relative frequency of abuse is higher in CDH sufferers than migraineurs, suggesting that physical and sexual abuse may be risk factors for chronification.

A variety of risk factors have been identified for chronification of headaches. These factors include female gender, Caucasian race, lower educational level, obesity, caffeine ingestion, hypothyroidism, and a history of having been previously married.[1,2]

Although population studies suggest that physical and sexual abuse are not uncommon in the population, limited data exist in regards to the influence of abuse in the primary headache disorders. Most of the available data are limited by lack of uniformity in the headache diagnosis and/or a small sample size. One notable exception is a preliminary study by Tietjen et al, which suggests a higher prevalence of abuse in patients reporting headache.[3,4,5,6,7]

Our study was designed to evaluate the relative frequency of physical and/or sexual abuse, self-reported by patients during a routine history and physical intake, with a primary diagnosis of CDH or migraine. We hypothesized that CDH patients would report a past history of abuse more frequently than migraine patients.


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