Pauline Anderson

March 07, 2016

Suffering emotional abuse as a child is associated with an increased risk for migraine in adulthood, a new study shows.

Emotional abuse, which might include being made to feel unwanted or unloved, "is just incredibly damaging," said lead author Gretchen Tietjen, MD, professor and chair, neurology, University of Toledo Medical School, and director, Migraine Treatment and Research Center, University of Toledo, Ohio.

Dr Tietjen will present her research at the upcoming American Academy of Neurology (AAN) 2016 Annual Meeting in Vancouver, British Columbia, Canada. Preliminary findings were released March 2.

This group has previously linked childhood emotional abuse with migraine rather than tension-type headache in a cross-sectional study of the 2007 survey responses of the longitudinal, population-based American Migraine Prevalence and Prevention study of 8305 patients with migraine and 1429 with tension-type headache.

They also found the risk for adult migraine was even higher in those subjected to two rather than just one type of maltreatment early in life.

The current study included data on 14,484 adults aged 24 to 32 years from wave 4 of the National Longitudinal Study of Adolescent Health. That study began in 1995 with wave 1 when the children were in grades 7 through 12. Wave 4 took place in 2007–2008.

In this wave, about 14% of the sample reported having a migraine diagnosis; the ratio was 3:1 for females to males. According to Dr Tietjen, this coincides with rates in the general population. The average age of diagnosis for study participants was 18 years.

During this wave, participants were asked, for the first time, to recall three types of abuse — emotional, physical, and sexual — that occurred during childhood. Participants reported at what age the abuse started and how many times it occurred.

Not Wanted

For emotional abuse, participants were asked how often, before their 18th birthday, a parent or other adult, such as a caregiver, said things that really hurt their feelings or made them feel like they were not wanted or loved. About 47% of participants said they had suffered such abuse.

About 18% said they had been physically abused, which was defined as being hit with a fist; kicked; or thrown down on the floor, into a wall, or down stairs. And about 5% of participants reported experiencing sexual abuse, which included forced sexual touching or sexual relations.

Childhood abuse was recalled by 60.5% of the participants with migraine and by 49% of those without migraine. Childhood abuse increased the chances of a migraine diagnosis by 55% (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.35 - 1.77), after adjustment for age, income, race, and sex.

The study showed a U-shaped curve. "If you were abused only once, you had a fairly high risk of having migraines, but if you were abused 2 times, 3 times, 4 times, 5 times, it was less, but then when it got to be 6 to 10 times and more, then the risk rose again," commented Dr Tietjen.

This coincides with the "theory of resilience or toughening up," she said.

When compared with physical and sexual abuse, emotional abuse had a stronger effect on migraine (OR, 1.52; 95% CI, 1.34 - 1.73).

"When we just looked at each type of abuse unadjusted for other abuse types, and not taking into consideration that maybe they had emotional and sexual, or emotional and physical abuse, we found that emotional, physical and sexual abuse each was significantly associated with a higher likelihood of migraine, emotional being the highest," explained Dr Tietjen. "But when we adjusted for the other abuse types, it was really only emotional abuse that was significant."

After adjustment for depression and anxiety, again, only emotional abuse remained significant. (OR, 1.33; 95% CI, 1.16 - 1.52).

The study does not show cause and effect, although Dr Tietjen pointed out that it does show that the more types of abuse a participant experienced, the greater the likelihood of adult migraine.

Childhood abuse can lead to adult migraine through several possible pathways. According to Dr Tietjen, probably the most plausible is the "stress pathway" or the hypothalamic-pituitary-adrenal axis.

Chronic emotional abuse can ultimately turn out to be more damaging than sporadic abuse of other types, she noted.

"If someone calls you a worthless person and wishes you had never been born every day of your life, that's very stressful, whereas maybe it's a different type of stress if a parent hit you at times when they got drunk, or if someone in the family sexually abused you and this only happened a few times, or there was support from other members of the family."

Meta-analyses looking at disability-adjusted life-years (DALYs) have indicated that emotional abuse has more of an effect than physical or sexual abuse on psychiatric health in adulthood, noted Dr Tietjen.

Another possible route from childhood abuse to adult migraine is through turning on, or interacting with, inflammation. Dr Tietjen noted that evidence shows migraine has an inflammatory component.

Therapy Choices

Some therapies may be better than others for patients with migraine who have suffered abuse. There's a suggestion, for example, that people who have experienced an early life stress might have an abnormal reaction to later stresses, so cognitive-behavioral therapy may be a good choice for these patients, said Dr Tietjen.

"That's one thing I would definitely personally recommend," she noted, and "not keep trying drug after drug that don't always work."

Another choice may be drugs that work on epigenetics, the idea that environmental exposures can change expression of genes.

Two antiseizure drugs that are approved by the US Food and Drug Administration for migraine — topiramate and valproic acid — may actually change epigenetics, said Dr Tietjen.

Interestingly, she said, both of these drugs are histone deacetylase (HDAC) inhibitors that may reverse epigenetic changes. HDAC inhibitors are being investigated as possible treatments for cancers as well as inflammatory diseases.

"Maybe these drugs aren't just working through some antiepileptic mechanism and calming the brain down; maybe they are also working because they're HDAC inhibitors and reversing some of the harmful things that went on earlier."

Wave 5 of the study has been approved. In this or later waves, Dr Tietjen said that researchers will look at conditions such as stroke and hypertension.

For a comment, Medscape Medical News reached Lawrence C. Newman, MD, director, The Headache Institute; attending neurologist, Mount Sinai St. Luke's Roosevelt, Mount Sinai Beth Israel, and Montefiore Medical Center; professor, clinical neurology, Albert Einstein College of Medicine (all in New York, New York), and president of the American Headache Society. 

"This is an interesting study," said Dr Newman. Although the study suggests a relationship between childhood abuse and migraine — especially emotional abuse — "this does not imply cause and effect," he stressed.

"Nonetheless, from a clinical perspective, it highlights the need for physicians to inquire about childhood abuse, especially in patients who present with migraine, since its presence may require more than pharmacologic therapy alone."

The study is supported by the University of Toledo and the Clair Martig Endowment.

American Academy of Neurology (AAN) 2016 Annual Meeting. Abstract 1944. Released March 2, 2016.

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