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Recalled maltreatment, migraine, and tension-type headache

"The initial trauma of a young child may go underground but it will return to haunt us." - James Garbarino

Many people carry around emotional pain from early life. Whether a person felt deprived of love and respect while growing up; experienced separation or divorce of parents; was a member of a dysfunctional family, including household members abusing drugs and alcohol; or, subjected to physical or sexual abuse, maltreatment in childhood is associated with a number of medical and psychological disorders.  Medical conditions include: headache, migraine, fibromyalgia, chronic pain conditions, cardiac conditions, and irritable bowel disease. Psychological conditions and behavioral issues include: depression, anxiety, panic disorder, obsessive compulsive disorder, dissociative disorder, and conduct disorder/legal problems (Buse et al., 2012).

To help us put the link between migraine and adverse childhood experiences (ACEs) into perspective, it is beneficial to review a bit about migraine and triggers. Migraine is a neurological disease. It is essential for us to know that, as persons with migraine, we are believed to have an inherited sensitivity of the nervous system that makes our brains hyperexcitable. This hyperexcitability gives us a predisposition to migraine attacks. Triggers are internal and external stimuli that "set-off" attacks in those of us who have the disease.

Migraine attacks may begin over many years in our lifetime. For example, it is thought that an unusual cluster of stressful life events may trigger the onset of migraine in some individuals who are predisposed to have migraine, while the onset of menstruation or menopause may trigger the onset of attacks in others (Sauro et al., 2009).

Keeping these things in mind, let's take a look at a recent study designed to test the hypothesis that ACEs are more strongly associated with migraine than episodic tension-type headache (Tietjen & Buse, 2014). Using the Childhood Trauma questionnaire (CTQ), rates of maltreatment, including emotional abuse, emotional neglect, and sexual abuse were evaluated in The AMPP Study, a large, US population-based sample of persons with migraine and tension-type headache (TTH). Results showed:  

  • The odds of migraine were greater in those with each ACE (emotional neglect, emotional abuse, and sexual abuse) as compared to those with TTH.
  • Although there were similar findings after adjusting for demographics, after adjusting for depression and anxiety the odds of migraine were greater only in those with emotional neglect, as compared to those with TTH.
  • Further, the odds of migraine, as compared to TTH, were greater in those with 2 versus 1 ACEs, even after adjustments for anxiety and depression.

To understand how ACEs may put us at increased risk for migraine expression, it is helpful for us to know some general information about the effects of ACEs. These include: maltreatment early in life may alter the brain's response to stress via the hypothalamus-pituitary adrenal system; inflammatory markers in adults have revealed higher levels in persons who have been exposed to maltreatment in childhood, suggesting a possible link; and, there is growing evidence that genes may be responsible for either increased vulnerability or resilience in response to early life stressful experiences (Buse et al., 2012).

Given ACEs may be perceived as psychological stress and there is a link between migraine and stress, we need to know:

  • Psychological stress can be defined as a state of mental or emotional strain or tension resulting from the perception of adverse, demanding, threatening, or dangerous circumstances (Buse & Lipton, 2015).
  • Factors (circumstances) perceived as demanding or threatening are referred to as stressors.
  • Stressors activate the physiological stress response, which involves the hypothalamic-pituitary-adrenal axis (HPA axis) and the sympathetic nervous system, including the adrenal medulla. When activated a range of hormones and neurotransmitters are released to maintain homeostasis and initiate survival mechanisms if necessary.
  • Along with initial onset of attacks, the potential effects of stress on migraine are thought to include: can act as a trigger for migraine attacks, including let-down stress; increase our susceptibility to other triggers; amplify attack intensity and duration; increase frequency of attacks and the risk for progression to chronic migraine; and, as migraine itself can be a stressor, create a vicious cycle.
  • Some reports indicate that we may process stressful events and situations differently than the general population and we may have more perceived life stressors.

 "You will find that it is necessary to let things go; simply for the reason that they are heavy." -     Humanity Healing with Ako C. Mischelle 

Chronic stress can wear out our HPA axis and increase our susceptibility to a number of conditions and disorders.  These include: heart disease, hypertension, asthma, obesity, diabetes, sexual dysfunction and menstrual irregularities, sleep disturbances, depression, anxiety and panic disorders, allergies, infections, and immune disorders.

While depression and anxiety have long been shown to be comorbid with migraine, we should be aware that in a study designed to evaluate the prevalence and characteristics of anger and emotional distress in migraine and TTH patients, results showed that chronic TTH and migraine associated with TTH present a significant impairment of anger control and suggest a connection between anger and the duration of our headache experience (Perozzo et al, 2005). The authors of another study (Hedborg et al, 2011) share that it is possible repressed feelings of anger may increase the perception of stress, which in turn may affect the course of migraine. 

Many of us may not discuss our emotions and mood disorders with our doctor or other health care professional because they don't ask us about them, or we are reluctant to share. In my situation, even though I was familiar with the body-mind-spiritual connection from my career in critical care nursing, I did not acknowledge this relationship in myself until my migraines became chronic and I ventured into Eastern medicine.

As I was guided through self-awareness, I learned how to understand and express my emotions to promote healing. Still, until I read, "Recalled maltreatment migraine, and tension-type headache," results of the AMPP study, I did not reflect on my initial onset of migraine attacks and the circumstances surrounding the beginning of my journey with this disease.    

As I recall the events of the summer I was 5 years old and my first memories of headaches, I remember my older sisters were 7 and 8 years old and my younger sister, 4. My father was in the hospital most of the time as he had just been diagnosed with acute rheumatoid arthritis. Towards the end of the summer, my mother was hospitalized for 'female surgery' and my father's oldest sister (a stranger to me) was given the task of escorting me to my first day of school. The following few years, as my father continued to fail in health, my younger sister was diagnosed with rheumatic fever and was in bed for most of her first year at school. Needless to say, attention was scarce and I would have to say, emotional neglect was unavoidable.

Probably, the worry, fear, anxiety and repressed feelings of anger ( I do not like confrontation so held the emotion inside) I experienced as a a child and continued throughout my adult years, not only played a role in the onset of my migraine attacks, as I had the genetic predisposition while my sisters did not, but contributed to their frequency, duration and severity until I learned to be honest in acknowledging my true feelings and express them in a healthy way. In other words, adulthood gave me a second chance to parent myself in a way that promotes love, respect, and healing (Maoshing Ni, 2008).

In Western medicine, cognitive behavioral therapy (CBT) can help decrease the frequency and severity of our attacks by making us more aware of triggers, including the association between stress and headache, and if we have been exposed to ACEs, help us identify and manage trauma related associated thoughts and feelings, and disorders like depression, panic disorder, obsessive-compulsive disorder, eating disorders, sleep disorders, and other comorbidities common with migraine.

As well, biofeedback therapy can help us increase awareness of functions related to our sympathetic nervous system, including heart rate and blood pressure, bring them under voluntary control and improve our circulation, and relieve muscle tension. Relaxation techniques, including diaphragmatic breathing, visual imagery, meditation, yoga, prayer, self-hypnosis, and guided imagery, can help us quiet our minds and calm our bodies.

The more we know about the body-mind-spiritual connection, the more we realize they cannot be separated. Physical illness affects our emotions and our emotions affect our physical health. As you read through this article, perhaps like me, you will reflect on the circumstances surrounding the onset of your first migraine attacks. Hopefully, if emotional strain, whether from ACEs or current challenges, impacts the frequency, severity and duration of your attacks, and you are not receiving the help you need, you will explore the appropriate resources.

I leave you with this quote, "Healing doesn't mean the damage never existed. It means the damage no longer controls our lives." - Author unknown. 

* A special "thank you" to Dawn C. Buse, PHD, Clinical Psychologist, Associate Professor of Neurology, Director of Behavioral Medicine, Montefiore Headache Center, New York, for reviewing this article and providing thoughtful comments and suggestions.


 Buse, D. C., Tietjen, G.E., & SCHulman, E.A. (2012). "Abuse, Childhood Maltreatment and Migraine." American Headache Society. 

Buse, D. C., & Lipton R. B. (2015). "Primary headache: What's stress got to do with it?"Cephalalgia. 0(0) 1-6. DOI: 10.1177/03333102414567382

Hedborg, K., Anderberg, U. M.,& Muhr, C. (2011). "Stress in migraine: personality-dependent vulnerability, life events, and gender are of significance." Upsala Journal of Medical Sciences. August; 116(3): 187-199.

Maoshing, Ni. Dr. Secrets of Self-Healing. New York: Avery, 2008.

Perozzo, P., Casttelli, S. L., et al. (2005). "Anger and emotional distress in patients with migraine and tension-type headache." J Headache Pain. Oct;6(5):392-9. 

Sauro, K. M., &Becker, W. J. (2009). "The Stress and Migraine Interaction." Current Review: Clinical Science. 

Tietjen, G. E., Buse, D. C., et al. (2014). "Recalled maltreatment, migraine, and tension-type headache." Neurology. December 24. 10.1212/WNL.0000000000001120.

Sharron Murray MS, RN is an author and coauthor CaMEO Study, "Life With Migraine". Currently, Sharron is active in the migraine community as a writer, advocate, American Migraine Foundation Partner, moderator for the American Migraine Foundation "Move Against Migraine" Facebook Group, and member of the National Headache Foundation Patient Leadership Council. 

Follow Sharron on twitter @murraysharron, her Facebook page: Sharron Murray, MS, RN 

This article is not intended as a substitute for medical advice. If you have any specific concerns about your health or nutrition, please consult a qualified health care professional.

Updated November 28, 3018

Copyright April, 2015, Sharron E. Murray


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