Table 1
Chronic Migraine Patients 30( 15.5 %)
reported sexual Abuse history
164( 84.5 %)
no reported sexual Abuse history episodic migraine patients 6( 4.4 %)
reported sexual Abuse history
129( 95.6 %)
no reported sexual Abuse history
Physicians should consider a patient’ s history of sexual abuse when assessing the various factors which may have led to transformation to chronic migraine. Although it may be difficult for patients to share this history with their physician – particularly at an initial visit – it is important that they do so. A patient’ s history of sexual abuse can be extremely relevant when formulating a treatment regimen for a patient with episodic migraine or chronic migraine. A migraine patient with such a history, for example, may benefit more from an antidepressant medication than from the use of a blood pressure agent, such as a beta blocker or calcium channel blocker. In addition, preventive medication may need to be considered even earlier in patients with abuse histories. These patients should participate in adjunctive treatment, including biofeedback and psychotherapy to help manage the anxiety and depression which often accompany a history of sexual abuse. Although psychotherapy is generally recommended for most migraine patients, abused patients may find a particular benefit from such intervention.
Future research is necessary to further establish a link between a history of sexual abuse and migraine transformation. Directions for future work include assessing the impact of childhood sexual abuse on migraine, studying the impact of sexual abuse or assault during adulthood on migraine, and analyzing the effectiveness of psychotherapy in migraine patients who have been victims of sexual abuse. A history of sexual abuse is more commonly reported in chronic migraine patients as compared to episodic migraine patients. A history of sexual abuse may be a contributing factor in the transformation of episodic migraine to chronic migraine. These findings underscore the importance of intervention, such as psychological counseling, in patients who have a history of sexual abuse. Episodic migraine may warrant more aggressive treatment in patients with a history of sexual abuse in order to help prevent transformation to chronic migraine. HW
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