Posttraumatic Stress Disorder in Migraine

Abstract

Objective.-To evaluate the relative frequency of posttraumatic stress disorder (PTSD) in episodic migraine (EM) and chronic daily headache (CDH) sufferers and the impact on headache-related disability.Background.-Approximately 8% of the population is estimated to have PTSD. Recent studies suggest a higher frequency of PTSD in headache disorders. The association of PTSD and headache-related disability has not been examined.Methods.-A prospective study was conducted at 6 headache centers. PTSD was assessed using the life events checklist and PTSD checklist, civilian version (PCL-C). We compared data from EM to CDH, and migraine with PTSD to migraine without PTSD. The PHQ-9 was used to assess depression, and headache impact test (HIT-6) to assess disability.Results.-Of 767 participants, 593 fulfilled criteria for EM or CDH and were used in this analysis. The mean age was 42.2 years and 92% were women. The frequency of PTSD was greater in CDH than in EM (30.3% vs 22.4%, P = .043), but not after adjusting for demographics and depression (P = .87). However, participants with major depression and PTSD were more likely to have CDH than EM (24.6% vs 15.79%, P < .002). Disability was greater in migraineurs with PTSD, even after adjustments (65.2 vs 61.7, P = .002).Conclusion.-The frequency of PTSD in migraineurs, whether episodic or chronic, is higher than the historically reported prevalence of PTSD in the general population. In addition, in the subset of migraineurs with depression, PTSD frequency is greater in CDH sufferers than in episodic migraineurs. Finally, the presence of PTSD is independently associated with greater headache-related disability in migraineurs.Key words: migraine, posttraumatic stress disorder, abuse, physical abuse, sexual abuse, chronic daily headache (Headache 2009;49:541-551) Migraine and abuse occur more often in women than in men, and abuse has been identified as possible risk factor for migraine chronification.

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

“…A similar distinction between EM and CM is seen with respect to anxiety disorders [12]. It has also been suggested that posttraumatic stress disorder occurs at a significantly higher rate in persons with CM than in EM [13], which may be explained in a subgroup of patients by childhood maltreatment [14]. CM patients tend to have a higher Body Mass Index than EM patients, and around 25 % of CM patients are obese [6].…”

Psychological trauma in chronic pain: Implications of PTSD for fibromyalgia and headache disorders

“…On the other hand, the relative frequency of PTSD in episodic migraine (EM) and chronic daily headache (CDH) sufferers and the impact on headache-related disability were also evaluated, and results showed that the frequency of PTSD in migraineurs, whether episodic or chronic, is higher than historically reported PTSD prevalence in the general population. In the subset of migraineurs with depression, PTSD frequency was greater in patients with CDH than in EM patients [48]. Another study assessed the relative frequency of self-reported PTSD in patients with EM and chronic/transformed migraine.…”

Treatment of PTSD and Chronic Daily Headache

“…Similarly, a recent study among veterans found that use of prescription headache medication (a proxy for headache diagnosis) was more robustly associated with PTSD than with lifetime traumatic events [29]. Further supporting the differential utility of PTSD symptomatology is the observed higher prevalence of PTSD among individuals with CM vs. EM [26,27] despite the similar prevalence and frequency of traumatic events experienced by both CM and EM patients [13,26,27].…”

“…PTSD, alternatively, requires exposure to a traumatic event and subsequent persistent behavioral, cognitive, and affective symptoms. Significant PTSD symptomatology is present in 30-43 % of treatment-seeking CM patients [26,27], and 19 % of CDH sufferers in the general population meet the structured interview criteria for PTSD, reflecting a minimum threefold increased odds of PTSD compared to those without headache [13]. With regard to the primary headache disorders, a pattern that has emerged across several studies suggests that headache is more strongly associated with PTSD than with trauma exposure per se, implying that PTSD may mediate the relationship between trauma and headache.…”

“…As PTSD interacts with depression and compounds headache-related disability [26], treating patients with PTSD and CDH presents particular challenges, and there are few treatment studies pertaining to this comorbid presentation. This paper provides an overview of evidence-based pharmacologic and behavioral interventions for treating PTSD, CDH, and their comorbid presentation in adults, as informed by systematic reviews, controlled trials, and practice guidelines.…”