Childhood abuse or neglect was reported by 58% of 1,348 migraine sufferers according to a study published in the current issue of Headache. Emotional abuse and neglect was particularly common. Patients with other chronic pain conditions also have high incidence of emotional, sexual, and physical abuse. Migraine patients who suffered abuse are also more likely to have anxiety and depression. We do not know what physiological mechanisms that are triggered by abuse lead to chronic pain. This and similar studies suggest that greater attention should be directed at the psychological factors that contribute to migraine headaches. One possible negative outcome of this study is that some physicians, who may already consider migraine to be a purely psychological disorder, will be even more inclined to avoid treating migraine as a biological disease. In practice, it means that these doctors will be even more reluctant to prescribe appropriate acute migraine medications, such as triptans (Imitrex and other). Migraine is clearly a biological disorder with documented genetic predisposition and should be treated as such. At the same time, we know that psychological factors play a major contributing role and should be also addressed when treating headache and pain patients.
