abuse in chronic migraine patients exists as compared to such a history in episodic migraine patients.
Medical records for new patients at a headache clinic during a 4-month period were reviewed. All new patients with a diagnosis of migraine or chronic migraine were included in the study. A total of 194 patients with a diagnosis of chronic migraine( defined by International Headache Society criteria as having ≥ 15 headache days per month for > 3 months) were included, while 135 patients with a diagnosis of episodic migraine were included.
Of the 329 patients included in this study, 10.9 % reported a history of sexual abuse across both chronic and episodic migraine. Six episodic migraineurs( 4.4 %) endorsed a history of sexual abuse, whereas 30 patients with chronic migraine( 15.5 %) indicated a previous history of sexual abuse. Patients with chronic migraine were 3 ½ times more likely than episodic migraine patients to report a history of sexual abuse.
As this study was conducted at a headache clinic, it would be expected to include more chronic migraine patients; in fact, there were 44 % more patients with chronic migraine than episodic migraine. It is likely that under-reporting of a sexual abuse history occurred in both patient groups, especially since the history was obtained during the initial office visit. Under-reporting is also considered to be very likely when these results are compared with national statistics regarding sexual abuse. The Centers for Disease Control estimated in 2014, that 1 in 4 girls and 1 in 6 boys are sexually abused before the age of 18, and that 18 % of women in the United States have been victims of rape.
These findings suggest that a history of sexual abuse may be an important factor in the transformation of episodic migraine to chronic migraine. Anxiety and depression, which are common in victims of abuse, are factors which are also associated with increased transformation to chronic migraine. Whether a history of sexual abuse has a direct causal relationship in this transformation is unclear; perhaps such a history worsens anxiety or depression which may, in turn, impact transformation to chronic migraine.
20 HeadWise ® | Volume 6, Issue 1 • 2016