Objective: To examine the relationship of recalled adverse childhood experiences (ACEs) with migraine and episodic tension-type headache (ETTH).
Methods: We conducted a cross-sectional analysis of ACEs among 2007 American MigrainePrevalence and Prevention Study survey respondents with ETTH and migraine. We modeled headache type using logistic regression adjusting for sociodemographic variables (age, race, sex, income), depression, and anxiety, and headache day frequency using ordinal logistic regression with a proportional odds model.Results: Participants had migraine (n 5 8,305) or ETTH (n 5 1,429). Rates of ACEs were significantly higher among respondents with migraine than ETTH for emotional neglect (24.5% vs 21.5%), emotional abuse (22.5% vs 16.7%), and sexual abuse (17.7% vs 13.3%). Odds of migraine vs ETTH were significantly higher for those reporting emotional neglect (odds ratio [OR] 5 1.23, 95% confidence interval [CI] 1.07-1.42), emotional abuse (OR 5 1.46, 95% CI 1.25-1.71), or sexual abuse (OR 5 1.35, 95% CI 1.11-1.62) when adjusted for sociodemographics. Results remained significant only for emotional abuse when adjusting for depression and anxiety (OR 5 1.33, 95% CI 1.13-1.57). Odds of migraine were higher with 2 (OR 1.52, 95% CI 1.25-1.86) vs 1 (OR 1.17, 95% CI 1.00-1.36) ACE, which held after adjusting for depression and anxiety. All forms of maltreatment were associated with higher headache day frequency category in migraine but results lost significance after adjusting for depression and anxiety.Conclusions: ACEs are associated with a higher risk of migraine vs ETTH. Attenuation of the influence of ACEs by depression and anxiety suggests confounding or mediation, although results for emotional abuse were generally maintained. Childhood maltreatment is a worldwide problem linked to a broad range of medical and psychiatric comorbidities in adulthood, including neurologic and pain disorders. [1][2][3][4][5][6][7][8] Estimates of the prevalence of childhood maltreatment based on self-report in adulthood range from 8% to nearly 40%.9-11 Frequent headache was associated with emotional, sexual, and physical abuse in the landmark Adverse Childhood Experiences (ACEs) Study but headache types were not differentiated. 12 Other pioneering studies support the association but are limited by the nature of their samples (e.g., subspecialty headache centers), incomplete characterization of headache subtypes, or limited assessment of ACEs. [6][7][8][13][14][15][16][17] Our objective was to test the hypothesis that ACEs are more strongly associated with migraine than episodic tension-type headache (ETTH). We evaluated rates of childhood emotional maltreatment (abuse and neglect) and sexual abuse in a large, US population-based