Many medical and pain conditions, including migraines, are more likely to occur in people who were abused in childhood. A new study by Richard Lipton and his colleagues compared the risk of developing migraines with the risk of developing episodic tension-type headache in people who experienced emotional abuse, emotional neglect, or sexual abuse. Episodic tension-type headaches are relatively mild and are experienced by most people from a variety of triggers, such as stress, sleep deprivation, hunger, and acute medical illness. Migraines, on the other hand, are much more severe and often cause inability to function and interfere with the quality of life.
Incidence of history of abuse was compared in 8,305 migraine sufferers and 1,429 people who had tension-type headaches. Emotional neglect and sexual abuse was more common in those with migraines but with these two types of abuse the development of migraine was linked to the development of anxiety and depression. Only those with emotional abuse had an increased risk of having migraines even without having anxiety and depression. All three forms of maltreatment were also associated with an increase in migraine headache frequency, but only when anxiety and depression was also present. This study also showed that having two or three forms of abuse was more likely to cause migraines than if only one type of abuse was reported.
Previous studies have also shown a correlation between the number of maltreatment types and pain conditions. These pain conditions include fibromyalgia, irritable bowel syndrome, interstitial cystitis, and temporo-mandibular joint disorder. Exposure to abuse or a traumatic event is thought to lead to a persistent increased excitability of the nervous system, which in turn makes one more predisposed to various pain conditions.
The importance of Lipton’s study is in reminding doctors who treat pain conditions to ask about maltreatment in childhood and about other traumatic events. Post-traumatic stress disorder is common in abuse victims and it needs to be recognized and addressed when treating migraines and pain. Psychological approaches, such as biofeedback and cognitive-behavioral therapy should always be included in the treatment of chronic pain and headaches, but it is particularly necessary in people with a history of abuse or emotional trauma.
