A University of Toledo study has linked childhood abuse and neglect to chronic migraine headaches and a constellation of chronic pain conditions.
Dr. Gretchen Tietjen, professor and chair of neurology, director of the Headache Treatment and Research Program, and director of the Stroke Program, led a two-year study using 1,348 patients with migraine headaches, including approximately 200 participants from the greater Toledo area.
“It’s been known for quite some time in the fields of pediatrics and psychology that childhood mistreatment carries various psychological affects into adulthood,” Tietjen said. “Not much research had been conducted in patients with migraines diagnosed by internationally accepted criteria.”
The participants sought care at 11 headache centers throughout the United States and Canada. During the course of their treatments, they provided information through interviews, exams and electronic surveys. The data included inquiries about pain conditions associated with migraine headaches, as well as responses to the Childhood Trauma Questionnaire.
Abuse and neglect were common, with the following types of maltreatment reported at the noted percentages:
• Physical abuse, 21 percent;
• Sexual abuse, 25 percent;
• Emotional abuse, 38 percent;
• Physical neglect, 22 percent; and
• Emotional neglect, 38 percent.
“Reports of childhood maltreatment, especially emotional abuse and neglect, are prevalent in outpatients with migraine,” according to the study’s conclusion.
Respondents with histories of abuse were more likely to report being treated for other chronic pain conditions such as irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, arthritis and interstitial cystitis.
“In general, the more types of abuse reported in childhood, the more pain conditions that were identified in adulthood,” Tietjen said. “This suggests that abuse is in some causal way related to other pain conditions.”
The study does not represent the general public, since respondents were identified as those with diagnosed migraine headaches. About 40 percent of study participants reported daily headaches.
“This is a population that is suffering enough to seek help from headache specialists,” Tietjen said, noting that migraine headaches also have been linked to depression and anxiety.
She cited previous studies showing that childhood maltreatment can alter the structure, function and genetics of the brain, and hopes her research leads to further understanding of relationships between early abuse and pain conditions.
“What we’re seeing is that the first pain condition a person develops tends to be headache, then other conditions follow,” she said. “It leads me to wonder if we can prevent subsequent pain conditions if we can effectively treat the headache.”
The UT study, which was published in this month’s edition of Headache: Journal of Head and Face Pain, was released in September. It was funded partially with a $15,000 grant from the American Headache Society.
Tietjen is planning further investigation into the mystery of chronic headaches.
“If we better understand what’s different about these patients, it may lead us to better treatment for refractory headache conditions,” she said. “We might be able to alter the body’s response to the stressors with cognitive therapies or use medications that target brain receptors that are key to headaches. But we have to understand it first.”