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


The prevalence of physical and sexual abuse in the general population is difficult to determine. Several limitations exist, including the patient's hesitancy to report physical and sexual abuse as well as inconsistent definitions and measurements of abuse in the studies that do exist.[3,4,5,6,9]

However, according to the World Report on Violence and Health, 22% of women in the United States report ever being physically assaulted by an intimate partner at some point in their lives.[10] The National Violence Against Women Survey reported 1 in 6 women (16.67%) in the United States has experienced an attempted or completed rape at some time in their lives. They also report 26% of women and 8% of men are victimized by intimate partners in the form of physical assault, rape, or stalking during the course of a lifetime.[11]

In the present study we have shown that the proportion of patients reporting a history of physical and/or sexual abuse is most significant for the subset of patients who are diagnosed with CDH. In this subset, it was reported in 40% of our patients compared to 27% of migraineurs.

Furthermore, the relative frequency of physical and sexual abuse in CDH patients versus episodic migraineurs in our study is comparable to what Tietjen et al found. In Tietjen's study, 30% of women with CDH had a history of sexual abuse compared to 31% in our study; and 29% of women with CDH had a history of physical abuse as compared to 26% in our study.[7]

Although our data indicate a higher frequency of abuse among CDH patients than migraineurs, cautions are required when interpreting our results. First, although subjects were systematically asked about a past history of abuse, this information was not further investigated, specifically in regards to the temporal relationship between the onset and end of the reported abuse and the onset of headaches.

Second, we did not obtain information in regards to socioeconomics or psychiatric disorders, including post-traumatic stress disorder (PTSD). This may be particularly important as a recent study by de Leeuw et al found that more than 16% of headache patients reported current symptoms consistent with a diagnosis of PTSD. (This was compared to a rate of about 10% in the general population.) Furthermore, the headache patients in de Leeuw's study included both tension-type headache patients and migraine patients.[12] This raises the possibility that the prevalence of PTSD may be even higher if CDH patients were studied.

Third, our study lacked a general population control. Thus, no comparison can be made in regards to abuse frequency in migraineurs and CDH patients compared to the general population.

Lastly, although significant, our results are not robust due to our restricted sample size. Despite its limitations, however, our study shows a higher frequency of abuse in CDH patients than in episodic migraine patients. This underscores the potential import of abuse in relation to headache chronification and presents a strong argument that a larger scale study is warranted to further characterize and delineate this association.

CLICK HERE for subscription information about this journal.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.