Emotional Abuse May Increase Headache-Related Disability

CHICAGO – Women with migraine who have experienced emotional abuse, either recently or in the past, report higher levels of comorbid depression and headache-related disability, Dr. Gretchen E. Tietjen said at the annual meeting of the American Headache Society.

The finding stimulates even more provocative questions about the connections between body and mind, she said. “Changes in the brain due to past abuse have been well documented,” said Dr. Tietjen, professor and chair of the department of neurology at the University of Toledo, Ohio. “You can't separate mental and physical health in these women. What we would like to know is how these changes affect headache and depression, and the common neurobiology that links them.”

She administered a survey that examined a history of emotional, physical, and sexual abuse, as well as headache characteristics, disability, somatic symptoms, and depression, to 1,032 women who sought care at a headache clinic. She divided the description of emotional abuse into six categories: threatening, aggressive, harassing, intimidating, isolating, and coercive/controlling.

Of the study group, 593 (57%) reported episodic headache (96% with migraine). The remainder reported chronic headache (87% with migraine).

Many of the women (43%) reported that they had experienced some kind of emotional abuse, and 6% of the group reported having been exposed to all six types. More than a third of the patients (37%) also reported a history of sexual abuse, with 18% describing a childhood or adolescent experience.

Dr. Tietjen saw a dose-response relationship: The more types of abuse the woman had experienced, the more severe or frequent her headaches and the greater number of additional symptoms she reported. Among those who denied a history of physical or sexual abuse, emotional abuse was associated with higher depression scores, which increased with an increase in the number of types of emotional abuse experienced.

Women who reported remote physical or sexual abuse seemed particularly vulnerable to the effects of later emotional abuse, with greater depression levels, higher stress, more somatic symptoms, and greater headache-related disability. All of these scores exhibited a dose-response relationship to the number of abusive behaviors the women experienced.

Questions about past and current abuse–both physical and emotional–should be part of a headache work-up for every patient, Dr. Tietjen said. “First, if a person is in an unsafe environment, we want to try and get her out. But a history of this experience may also change the type of therapy we offer.”

These patients may respond well to cognitive-behavioral and physical therapy as adjunctive treatments, Dr. Tietjen said.

CHICAGO – Women with migraine who have experienced emotional abuse, either recently or in the past, report higher levels of comorbid depression and headache-related disability, Dr. Gretchen E. Tietjen said at the annual meeting of the American Headache Society.

The finding stimulates even more provocative questions about the connections between body and mind, she said. “Changes in the brain due to past abuse have been well documented,” said Dr. Tietjen, professor and chair of the department of neurology at the University of Toledo, Ohio. “You can't separate mental and physical health in these women. What we would like to know is how these changes affect headache and depression, and the common neurobiology that links them.”

She administered a survey that examined a history of emotional, physical, and sexual abuse, as well as headache characteristics, disability, somatic symptoms, and depression, to 1,032 women who sought care at a headache clinic. She divided the description of emotional abuse into six categories: threatening, aggressive, harassing, intimidating, isolating, and coercive/controlling.

Of the study group, 593 (57%) reported episodic headache (96% with migraine). The remainder reported chronic headache (87% with migraine).

Many of the women (43%) reported that they had experienced some kind of emotional abuse, and 6% of the group reported having been exposed to all six types. More than a third of the patients (37%) also reported a history of sexual abuse, with 18% describing a childhood or adolescent experience.

Dr. Tietjen saw a dose-response relationship: The more types of abuse the woman had experienced, the more severe or frequent her headaches and the greater number of additional symptoms she reported. Among those who denied a history of physical or sexual abuse, emotional abuse was associated with higher depression scores, which increased with an increase in the number of types of emotional abuse experienced.

Women who reported remote physical or sexual abuse seemed particularly vulnerable to the effects of later emotional abuse, with greater depression levels, higher stress, more somatic symptoms, and greater headache-related disability. All of these scores exhibited a dose-response relationship to the number of abusive behaviors the women experienced.

Questions about past and current abuse–both physical and emotional–should be part of a headache work-up for every patient, Dr. Tietjen said. “First, if a person is in an unsafe environment, we want to try and get her out. But a history of this experience may also change the type of therapy we offer.”

These patients may respond well to cognitive-behavioral and physical therapy as adjunctive treatments, Dr. Tietjen said.

CHICAGO – Women with migraine who have experienced emotional abuse, either recently or in the past, report higher levels of comorbid depression and headache-related disability, Dr. Gretchen E. Tietjen said at the annual meeting of the American Headache Society.

The finding stimulates even more provocative questions about the connections between body and mind, she said. “Changes in the brain due to past abuse have been well documented,” said Dr. Tietjen, professor and chair of the department of neurology at the University of Toledo, Ohio. “You can't separate mental and physical health in these women. What we would like to know is how these changes affect headache and depression, and the common neurobiology that links them.”

She administered a survey that examined a history of emotional, physical, and sexual abuse, as well as headache characteristics, disability, somatic symptoms, and depression, to 1,032 women who sought care at a headache clinic. She divided the description of emotional abuse into six categories: threatening, aggressive, harassing, intimidating, isolating, and coercive/controlling.

Of the study group, 593 (57%) reported episodic headache (96% with migraine). The remainder reported chronic headache (87% with migraine).

Many of the women (43%) reported that they had experienced some kind of emotional abuse, and 6% of the group reported having been exposed to all six types. More than a third of the patients (37%) also reported a history of sexual abuse, with 18% describing a childhood or adolescent experience.

Dr. Tietjen saw a dose-response relationship: The more types of abuse the woman had experienced, the more severe or frequent her headaches and the greater number of additional symptoms she reported. Among those who denied a history of physical or sexual abuse, emotional abuse was associated with higher depression scores, which increased with an increase in the number of types of emotional abuse experienced.

Women who reported remote physical or sexual abuse seemed particularly vulnerable to the effects of later emotional abuse, with greater depression levels, higher stress, more somatic symptoms, and greater headache-related disability. All of these scores exhibited a dose-response relationship to the number of abusive behaviors the women experienced.

Questions about past and current abuse–both physical and emotional–should be part of a headache work-up for every patient, Dr. Tietjen said. “First, if a person is in an unsafe environment, we want to try and get her out. But a history of this experience may also change the type of therapy we offer.”

These patients may respond well to cognitive-behavioral and physical therapy as adjunctive treatments, Dr. Tietjen said.