Potentially traumatic interpersonal events, psychological distress and recurrent headache in a population-based cohort of adolescents: the HUNT study

Abstract

ObjectivesRecurrent headache co-occurs commonly with psychological distress, such as anxiety or depression. Potentially traumatic interpersonal events (PTIEs) could represent important precursors of psychological distress and recurrent headache in adolescents. Our objective was to assess the hypothesised association between exposure to PTIEs and recurrent migraine and tension-type headache (TTH) in adolescents, and to further examine the potential impact of psychological distress on this relationship.DesignPopulation-based, cross-sectional cohort study. The study includes self-reported data from youth on exposure to potentially traumatic events, psychological distress and a validated interview on headache.SettingThe adolescent part of the Nord-Trøndelag Health Study 2006–2008 (HUNT), conducted in Norway.ParticipantsA cohort of 10 464 adolescents were invited to the study. Age ranged from 12 to 20 years. The response rate was 73% (7620), of whom 50% (3832) were girls.Main outcome measuresData from the headache interview served as the outcome. Recurrent headache was defined as headache recurring at least monthly during the past year, and was subclassified into monthly, weekly and daily complaints. Subtypes were classified as TTH, migraine, migraine with TTH and/or non-classifiable headache, in accordance with the International Classification of Headache Disorders criteria, second edition.ResultsMultiple logistic regression analysis, adjusted for sociodemographics, showed consistently significant associations between exposure to PTIEs and recurrent headache, regardless of the frequency or subtype of headache. Increasing exposure to PTIEs was associated with higher prevalence of recurrent headache, indicating a dose–response relationship. The strength of associations between exposure to PTIEs and all recurrent headache disorders was significantly attenuated when psychological distress was entered into the regression equation.ConclusionsThe empirical evidence of a strong and cumulative relationship between exposure to PTIEs, psychological distress and recurrent headache indicates a need for the integration of somatic and psychological healthcare services for adolescents in the prevention, assessment and treatment of recurrent headache. Prospective studies are needed.

A Conceptual Framework for Understanding the Role of Adverse Childhood Experiences in Pediatric Chronic Pain

“…Evidence also suggests that children and adolescents (up to age 20) with certain chronic pain conditions (e.g., fibromyalgia, abdominal pain, recurrent headache) report a higher number of ACEs experienced (≥1) across adolescence than healthy comparison cohorts 7,8,23 . There may also be differences within subpopulations such as adolescents with widespread pain more likely to report more frequent experience of abuse/trauma than those with chronic migraine 24 .…”

“…However, given the cross-sectional nature of all of these studies, it is unclear if ACEs increases risk for the development or maintenance of chronic pain and/or pain related impairment. Pain outcomes may also vary depending on frequency of experiences, with multiple ACEs (e.g., complex trauma) during childhood associated with greatest impairment 8,25,26 as compared to a single ACE. However, similar to adult research, most of these studies are limited inferentially, as the existing literature on youth populations includes predominantly cross-sectional data on only a subset of pain disorders (e.g., migraine, functional abdominal pain, fibromyalgia).…”

“…Prior studies have defined adverse childhood experiences (ACEs) as physical, mental, or sexual abuse, emotional or physical neglect, a violent home environment, household substance abuse, exposure to parent mental illness, parental separation or divorce, and parental incarceration 4 . In the pain literature, the relationship between ACEs and increased risk for pain and maladaptive pain outcomes have mostly been investigated in the context of retrospective accounts in adulthood, usually restricted to abuse or trauma 4–6 ; and a few studies in youth have suggested that ACEs are reported more often by children and adolescents with pain syndromes (e.g., migraine headaches, fibromyalgia) than their healthy peers 7,8 . However, little is known about how ACEs may impact concurrent or long-term outcomes in youth with chronic pain and much work is needed in this area.…”

Psychiatric Comorbidity in Childhood and Adolescence Headache

“…Recently, exposure to interpersonal violence has been posed as potential triggers of headache in adults [3, 103] and adolescents [31, 33, 97] although documentation is scarce [65, 75]. …”

Childhood violence and adult chronic pain among indigenous Sami and non-Sami populations in Norway: a SAMINOR 2 questionnaire study

“…Health effects of violence may be devastating: childhood violence is associated with poorer mental health (5–10) and several studies have documented that children exposed to interpersonal violence have increased risk of chronic pain conditions in adulthood, such as headache, pelvic pain, muscular and abdominal pain (11–15). …”