Sexual abuse history may promote migraine transformation

VALENCIA, SPAIN – A history of childhood sexual abuse is nearly fourfold more common among chronic migraine patients than in those with episodic migraine, Dr. Brad Torphy reported at the International Headache Congress.

This association raises the possibility that prior sexual abuse is a contributing factor in the transformation from episodic migraine – defined as fewer than 15 headache days per month – to the more serious and difficult-to-treat chronic migraine, which entails headaches on 15 or more days monthly, said Dr. Torphy of Diamond Headache Clinic in Chicago.

Dr. Brad Torphy

“The clinical implications of these findings, and what I’m stressing, is the importance of intervention – such as psychological counseling – in episodic migraine patients who have a history of abuse. The other key point is that patients who have episodic migraine may warrant more aggressive therapy, including going on preventive medications sooner, if they have a history of sexual abuse, because they’re probably at risk for progression to chronic migraine,” he said in an interview at the meeting.

Dr. Torphy presented a retrospective study of all new patients seen at the Diamond Headache Clinic during the final 4 months of last year. The new-patient questionnaire includes a section about past sexual abuse. Such a history was reported by 6 (4.4%) of the 135 episodic migraine patients, compared with 30 (15.5%) of the 194 patients with chronic migraine.

“What made me think about doing this study is that at the Diamond Clinic every week we have a meeting with our psychology group, and it just seemed like week after week so many patients had these horrifying stories of their childhood. I thought there must be a connection between that history of sexual abuse and progression to chronic migraine,” he said.

He added that, based upon his experience in the clinic, he suspects that the true proportion of patients with a positive history for sexual abuse is considerably higher than the rates the new-patient questionnaire would suggest.

“A lot of factors would lead to that being a very low number. It’s the patient’s first visit, and it’s a paper questionnaire so patients may not be comfortable checking that box when they don’t know who’s going to see the results. I’ve had cases where patients shared with me only after two or three visits that, yes, I do have that history. I think it’s underreported across the board,” Dr. Torphy continued.

In his review of the literature he found that other investigators have tended either to lump together all kinds of abuse – physical, emotional, and sexual – in analyzing an association with migraine, or if they looked at sexual abuse in particular it was in association with all types of chronic pain, not specifically migraine.

The meeting was sponsored by the International Headache Society and the American Headache Society. Dr. Torphy reported no financial conflicts.

bjancin@frontlinemedcom.com