Physical/Sexual Abuse Predicts Chronic Headache, Depression in Women

Physical/Sexual Abuse Predicts Chronic Headache, Depression in Women

PHILADELPHIA—A history of physical or sexual abuse during childhood is a strong predictor of chronic headache in women, researchers reported at the recent annual meeting of the American

Headache Society. Analyzing a cross-sectional survey of women seen in headache clinics, investigators found that physical and/or sexual abuse were associated with chronic

headache. A history of sexual abuse under age 12 years was a strong predictor of

chronic headache later in life. A history of abuse was also an independent predictor of: • Major depression (P = .001)• Increased somatic symptoms (P = .001) • Past or current substance abuse. Getchen Tietjen, MD, chairman, Department of Neurology, Medical University

of Ohio, Toledo, and colleagues gave 1032 women at 6 geographically diverse sites a self-administered questionnaire that included demographic and social variables; age at onset of headache; and questions about physical, sexual, emotional, and other abusive behaviors. Headache diagnosis and frequency were determined by a physician according to International

Headache Society criteria. Among respondents completing the questionnaire, 42.5% had chronic headache (87% migraine) and 57.5% had episodic headache (96% migraine). All 6 sites reported fairly consistent data. Of these respondents, 24% reported a history of physical or sexual abuse, both of which were more common among women with chronic headache than with episodic

headache (physical abuse odds ratio [OR], 1.4; sexual abuse OR, 1.6). An even stronger association with chronic headache was noted if abuse occurred during childhood (physical abuse

OR, 1.6; P = .01; sexual abuse OR, 2.1; P = .003; emotional abuse OR, 2.2; P = .005).

All ORs were adjusted for age, income, education, and race.Additional risk factors associated with chronic headache were witnessing abuse between adults in the childhood home or

fearing for one’s life because of abuse. These women were also more likely to fear

future abuse and feel stress from threats or violent behavior. “[For] fear for future

abuse, the odds ratio was very high at 3.6,” Dr Tietjen said. “Abuse, particularly sexual

abuse, occurring in childhood is associated with chronic headache, and…history of abuse appears to be an independent predictor of major depression and presomatic

symptoms and substance abuse in chronic headache sufferers.” Given these findings, Peter Goadsby, MD, of the National Hospital for Neurology and Neurosurgery, London,

commented that physicians need better training to ask about abuse. Dr Goadsby

noted that male physicians in particular are not used to exploring such areas; he

admitted embarrassment about not raising the issue with his own patients. “If this is

something that affects 1 in 3 of the [female] patients I see, why is it that I don’t

think about it more?” he asked. “If people… ask questions about abuse and know

what to do when they get the information, they’ll take it forward.” He added that men may also have issuesrelated to abuse.