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NEUROLOGY 2007;69:959-968
© 2007 American Academy of Neurology

History of childhood maltreatment is associated with comorbid depression in women with migraine

G. E. Tietjen, MD, J. L. Brandes, MD, K. B. Digre, MD, S. Baggaley, MS, FNP, V. T. Martin, MD, A. Recober, MD, L. O. Geweke, MD, F. Hafeez, MD, S. K. Aurora, MD, N. A. Herial, MD, MPH, C. Utley, MSN, CNP and S. A. Khuder, MPH, PhD

From The University of Toledo (G.E.T., F.H., N.A.H., C.U., S.A.K.), OH; Nashville Neuroscience Group (J.L.B.), TN; The University of Utah (K.B.D., S.B.), Salt Lake City; The University of Cincinnati (V.T.M.), OH; The University of Iowa (A.R., L.O.G.), Iowa City; and Swedish Medical Center (S.K.A.), Seattle, WA.

Address correspondence and reprint requests to Dr. Gretchen E. Tietjen, 3120 Glendale Avenue, RHC 1450, Department of Neurology, College of Medicine, The University of Toledo-Health Science Campus, Toledo, OH 43614 gretchen.tietjen{at}utoledo.edu

Background: A bidirectional relationship between migraine and depression suggests a neurobiological link. Adverse experiences, particularly childhood maltreatment, may alter neurobiological systems, and predispose to a multiplicity of adult chronic disorders. Our objective is to determine, within a headache clinic population of women, if depression moderates the abuse-migraine relationship.

Methods: At six headache specialty clinics, women with migraine were diagnosed using ICHD-II criteria, and frequency was recorded. A questionnaire regarding maltreatment history, headache characteristics, current depression, and somatic symptoms was completed.

Results: A total of 949 women with migraine completed the survey: 40% had chronic headache (≥15 headache days/month) and 72% had "very severe" headache-related disability. Major depression was recorded in 18%. Physical or sexual abuse was reported in 38%, and 12% reported both physical and sexual abuse in the past. Migraineurs with current major depression reported physical (p < 0.001) and sexual (p < 0.001) abuse in higher frequencies compared to those without depression. Women with major depression were more likely to report sexual abuse occurring before age 12 years (OR = 2.30, 95% CI: 1.14 to 4.77), and the relationship was stronger when abuse occurred both before and after age 12 years (OR = 5.08, 95% CI: 2.15 to 11.99). Women with major depression were also twice as likely to report multiple types of maltreatment (OR = 2.07, 95% CI: 1.27 to 3.35) compared to those without depression.

Conclusions: Childhood maltreatment was more common in women with migraine and concomitant major depression than in those with migraine alone. The association of childhood sexual abuse with migraine and depression is amplified if abuse also occurs at a later age.

Supported by a grant from the American Headache Society to the Women's Issue Section.

Disclosure: Dr. Tietjen has received grants/research support from GlaxoSmithKline, Ortho-McNeil, Merck, Boehriger-Ingelheim, and NMT Medical, Inc.; has served as a scientific consultant to GlaxoSmithKline; and has received an honorarium from Pfizer. Dr. Brandes has received grants/research support from Merck, GlaxoSmithKline, UCB Pharma, Allergan, Johnson & Johnson, AstraZeneca, Pfizer Inc., Bristol-Myer Squibb, Winston Laboratories, Sanofi-Aventis, Elan Pharmaceuticals, Novartis, Endo Pharmaceuticals, Pozen Inc., Vernalis, Ortho-McNeil, and Advanced Bionics; has participated in speakers' bureaus for GlaxoSmithKline, AstraZeneca, Pfizer Inc., Merck, Ortho-McNeil, Allergan, MedPointe Pharmaceuticals, Endo Pharmaceuticals, and UCB Pharmaceuticals; has served as consultant for Merck, GlaxoSmithKline, Pfizer Inc., AstraZeneca, Allergan, Ortho-McNeil, and Aradigm Corporation; and has received an educational grant from GlaxoSmithKline. Dr. Digre has participated in speakers' bureau for GlaxoSmithKline, Merck, US Human Health, AstraZeneca, Pharmacia, Ortho-McNeil, Pfizer Inc., Abbot Laboratories, Allergan, and Endo Pharmaceuticals. S. Baggaley has no financial interest to disclose. Dr. Martin has served as a consultant for AstraZeneca, GlaxoSmithKline, Pfizer Inc., Ortho-McNeil, Endo Pharmaceuticals, and Merck; has financial disclosures with Johnson & Johnson, Merck, and GlaxoSmithKline; and has participated in speakers' bureaus for GlaxoSmithKline, AstraZeneca, Merck, Ortho-McNeil, Endo and Pfizer Inc. Dr. Recober has no conflicts of interest to report. Dr. Geweke has participated in speakers' bureaus for Ortho-McNeil, GlaxoSmithKline, Valeant Pharmaceuticals International, and Pfizer Inc. Dr. Geweke has received grants/research support from AGA Medical. Dr. Hafeez has received honoraria from Pfizer, Ortho-McNeil, GlaxoSmithKline, Sanofi-Aventis, and Bristol-Myers Squib; and has received grants/research support from GlaxoSmithKline, Ortho-McNeil, Merck, Boehriger-Ingelheim, and NMT Medical, Inc. Dr. Aurora has received grants/research support from Alexza Pharmaceuticals, Inc., GlaxoSmithKline, AstraZenca, Allergan, Winston, and Merck; has consulted for Ortho-McNeil, AstraZeneca, Merck, GlaxoSmithKline, Pfizer Inc., Allergan, Neuralieve, and NMT Medical, Inc.; and has received honoraria from AstraZeneca, Merck, GlaxoSmithKline, Pfizer Inc., Ortho-McNeil, and Valeant Pharmaceuticals International. Dr. Herial has no financial interest to disclose. C. Utley has no financial interest to disclose. Dr. Khuder has no financial interest to disclose. The American Headache Society had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Presented in part at the 47th annual scientific meeting of the American Headache Society; Philadelphia, PA; June 2005.

Received December 15, 2006. Accepted in final form April 6, 2007.






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