Impact of Abuse on Migraine Symptoms and Comorbidity: Results from the American Registry for Migraine Research (ARMR)
Meesha Trivedi1, Gina Dumkrieger1, Catherine Chong1, David Dodick1, Todd Schwedt1
1Mayo Clinic
To examine associations between a history of emotional, physical, and sexual abuse with the severity of sensory hypersensitivity symptoms in patients with migraine, and to explore the mediating effect of psychiatric comorbidities.
Prior studies have established an association between abuse and development of migraine and suggested this is attenuated after controlling for depression. Few studies have investigated abuse and individual migraine symptoms.

1,020 adult patients with migraine from the American Registry for Migraine Research completed questionnaires: Generalized Anxiety Disorder-7, Patient Health Questionnaire-2 for depression, Photosensitivity Assessment Questionnaire, Hyperacusis Questionnaire, and Allodynia Symptom Checklist. Patients self-reported abuse history. T-tests compared questionnaire scores between groups with and without a history of abuse. Linear regression models adjusted for demographics and headache frequency analyzed the association between abuse and sensory hypersensitivity symptoms. Adjusted mediation models analyzed the indirect mediated effect (IE) of abuse on sensory hypersensitivity through depression or anxiety.


36% of participants reported a history of abuse (n=365). Abuse was associated with greater headache frequency (p=0.019), anxiety (p<0.001), depression (p<0.001), photophobia (p<0.001), hyperacusis (p<0.001), ictal allodynia (p<0.001), and interictal allodynia (p=0.001). After controlling for age, gender, and headache frequency, abuse was significantly associated with photophobia (B=0.111, p<0.001), hyperacusis (B=4.328, p<0.001), ictal allodynia (B=0.125, p<0.001), and interictal allodynia (B=0.109, p=0.002). Anxiety significantly mediated the relationships between abuse with photophobia (IE=0.027, 95% CI=0.015-0.041), hyperacusis (IE=1.256, 95% CI=0.828-1.752), and ictal allodynia (IE=0.015, 95% CI=0.002-0.028). Depression significantly mediated the relationship between abuse with photophobia (IE=0.026, 95% CI=0.015-0.040), hyperacusis (IE=1.057, 95% CI=0.662-1.514), and ictal allodynia (IE=0.019, 95% CI=0.007-0.032).

A history of abuse is associated with greater migraine-related sensory hypersensitivity symptoms. Further research on the pathophysiological mechanisms underlying the relationship between abuse, psychiatric comorbidities, and migraine symptoms is needed and could lead to interventions that reduce the negative impact of abuse on the expression and severity of migraine symptoms.