A history of abuse is associated with more severe migraine‐ and pain‐related disability: Results from the American Registry for Migraine Research

• Published in: Headache 2024-10, Vol.64 (9), p.1109-1123
• Main Authors: Trivedi, Meesha, Dumkrieger, Gina, Chong, Catherine D., Leibovit‐Reiben, Zachary, Schwedt, Todd J.
• Format: Article
• Language: English
• Subjects: Abuse; Adult; Anxiety; Anxiety - epidemiology; Anxiety disorders; Cognitive ability; Complications; Cross-Sectional Studies; depression; Depression - epidemiology; disability; Disability Evaluation; Female; Headache; Humans; Impact analysis; Impairment; Male; Mental depression; Middle Aged; Migraine; Migraine Disorders - epidemiology; Observational studies; Pain; Patients; Population studies; productivity; Questionnaires; Registries; Severity of Illness Index; Sexual assault; trauma; United States - epidemiology
• ISSN: 0017-8748; 1526-4610; 1526-4610
• DOI: 10.1111/head.14787

Background Prior studies have established an association between a history of abuse and more severe migraine presentation. Objectives This cross‐sectional, observational study of a clinic‐based migraine population used validated measures to elucidate migraine‐specific and migraine‐related burdens among patients with a history of abuse. Methods Patients with migraine (n = 866) from the American Registry for Migraine Research self‐reported if they had a history of emotional, physical, and/or sexual abuse and completed questionnaires assessing migraine‐related burden: Migraine Disability Assessment, Subjective Cognitive Impairment Scale for Migraine Attacks, Work Productivity and Activity Impairment, Patient‐Reported Outcomes Measurement Information System Pain Interference, Patient Health Questionnaire‐2, and Generalized Anxiety Disorder‐7. Migraine‐related burden in patients with versus without a history of abuse was compared. Subsequently, a mediation analysis evaluated the impact of depression and anxiety symptoms in the relationship between abuse history and migraine burden. Results A history of abuse was reported by 36.5% (n = 316/866) of participants. After controlling for patient age, sex, years lived with headache, and headache frequency, a history of abuse was significantly associated with more severe migraine‐related disability. The combined burden of depression and anxiety symptoms mediated the relationship. Conclusion A history of abuse is associated with greater migraine‐related disability. Future studies should determine if identification and management of the psychological and physical sequelae of abuse reduce migraine burden. Plain Language Summary In this study, we found that patients with migraine who participated in the American Registry for Migraine Research and self‐reported a history of emotional, physical, or sexual abuse had worse migraine‐related burden than patients with migraine without a history of abuse. For example, patients who are survivors of abuse described a greater impact of migraine on their work, day‐to‐day living, and cognition. This increased migraine burden may be because of depression and anxiety, and we wonder if treating the underlying causes of these mental health difficulties might reduce their migraine burden.