Child abuse and neglect are, sadly, more common than you might think. According to a 2011 study in JAMA Pediatrics, more than five million U.S. children experienced confirmed cases of maltreatment between 2004 and 2011. The effects of abuse can linger beyond childhood – and migraine headaches might be one of them.
Previous research, including our own, has found a link between experiencing migraine headaches in adulthood and experiencing emotional abuse in childhood. So how strong is the link?
What is it about childhood emotional abuse that could lead to a physical problem, like migraines, in adulthood?
The discrepancy may be because so many cases of childhood abuse, particularly cases of emotional or psychological abuse, are unreported. This specific type of abuse may occur within a family over the course of years without recognition or detection.
While all forms of childhood maltreatment have been shown to be linked to migraines, the strongest and most significant link is with emotional abuse. Two studies using nationally representative samples of older Americans (the mean ages were 50 and 56 years old, respectively) have found a link.
We have also examined the emotional abuse-migraine link in young adults. In our study, we found that those recalling emotional abuse in childhood and adolescence were over 50 percent more likely to report being diagnosed with migraine. We also found that if a person reported experiencing all three types of abuse (physical, emotional and sexual), the risk of being diagnosed with migraine doubled.
Why Would Emotional Abuse In Childhood Lead To Migraines In Adulthood?
The fact that the risk goes up in response to increased exposure is what indicates that abuse may cause biological changes that can lead to migraine later in life. While the exact mechanism between migraine and childhood maltreatment is not yet established, research has deepened our understanding of what might be going on in the body and brain.
Adverse childhood experiences are known to upset the regulation of what is called the hypothalamic-pituitary-adrenal (HPA) axis, which controls the release of stress hormones. In plain English, that means experiencing an adverse event in childhood can disrupt the body’s response to stress. Stress isn’t just an emotion – it’s also a physical response than can have consequences for the body.
Prolonged elevation of these stress hormones can alter both the structure and function of the brain’s limbic system, which is the seat of emotion, behavior, motivation and memory. MRIs have found alterations in structures and connections within the limbic system both in people with a history of childhood maltreatment and people diagnosed with migraine. Stressful experiences also disrupt the immune, metabolic and autonomic nervous systems.
Migraine is considered to be a hereditary condition. But, except in a small minority of cases, the genes responsible have not been identified. However, stress early in life induces alterations in gene expression without altering the DNA sequence.
What Does This Mean For Doctors Treating Migraine Patients?
Childhood maltreatment probably contributes to only a small portion of the number of people with migraine. But because research indicates that there is a strong link between the two, clinicians may want to bear that in mind when evaluating patients.
Treatments such as cognitive behavioral therapy, which alter the neurophysiological response to stress, have been shown to be effective treatments for migraine and also for the psychological effects of abuse. Therefore CBT may be particularly suited to persons with both.
Migraineurs with history of childhood abuse are also at higher risk for psychiatric conditions like depression and anxiety, as well as for medical disorders like fibromyalgia and irritable bowel syndrome. This may affect the treatment strategy a clinician uses.