A notable prevalence of childhood abuse – physical, sexual, verbal, or emotional – in migraine patients has been observed and documented over the last few years. In fact, it has emerged as a significant enough issue for the American Headache Society to devote an entire plenary session to it at its annual scientific conference in Washington this week.
The session “Maltreatment in Headache: Epidemiology, Neurobiology, Evaluation and Treatment,” led by Gretchen E. Tietjen, MD, a leading investigator in the field, will be at 11 am, Thursday, June 2 in the Grand Hyatt Washington. Dr. Tietjen is Director of University of Toledo Medical Center’s Headache Treatment and Research Program.
“We are finding an unusually high prevalence of childhood abuse in migraine patients.” Dr. Tietjen said. “This seems to be more than a psychological reaction to maltreatment. We are examining the idea that early abuse – no matter what kind – creates permanent changes in the neurobiological system of abused persons that may make them more prone to migraine pain.”
Dr. Tietjen said there is considerable preclinical and clinical evidence that chronic early life stress results in changes in the neuroendocrine system that controls reactions to stress and regulates many body processes, including the immune system as well as mood, emotions, and sexuality. “We are interested in exploring the idea that treatment with serotonin-specific reuptake inhibitors may actually reverse some of the neurobiological effects of maltreatment, including decreasing the hormonal response to stress.”
Addressing the issue of asking patients about potential abuse will be discussed by Dr. Elliott Schulman, Adjunct Clinical Professor of Neurology at Jefferson School of Medicine in Philadelphia.
Dr. Tietjen said. “Many patients seem relieved when we ask them about abuse, but we need more much more research to tell us if such information can really influence how we treat them.” In some cases patients are referred for psychological counseling which may or may not help their migraine condition, but Dr. Tietjen acknowledged that such questions may not be easy for neurologists to ask.
About Migraine Headaches
Some 36 million Americans suffer from migraine, more than have asthma or diabetes combined. Migraine is characterized by pulsating or throbbing headache pain which can be moderate to severe in intensity. Its severity can be extremely disabling for sufferers, painful enough to cause work loss and absence from activities with family and friends. Migraine costs the United States more than $20 billion each year. Costs are attributed to direct medical expenses (e.g. doctor visits, medications) and indirect expenses (e.g. missed work, lost productivity).
Material adapted from MBooth & Associates.