Objective:

This cross-sectional, observational study of a clinic-based migraine population uses validated measures to elucidate migraine-specific and migraine-related burden among patients with a history of abuse.

Background:

Prior studies have established an association between a history of abuse and more severe migraine presentation. 

Design/Methods:

741 adult patients with migraine from ARMR self-reported their history of emotional, physical, and/or sexual abuse and completed questionnaires: Migraine Disability Assessment (MIDAS), Subjective Cognitive Impairment Scale for Migraine Attacks (Mig-SCog), Work Productivity and Activity Impairment (WPAI), PROMIS Pain Interference (PROMIS-PI), Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder-7 (GAD-7), and sociodemographics questionnaire. Differences in questionnaire scores between patients with and without a history of abuse were determined. A series of adjusted regression models qualified this relationship. A parallel mediation analysis evaluated the effects attributable to depression and anxiety.
 

Results:

36.4% (n=270) of participants reported a history of abuse. Patients with a history of abuse reported significantly greater headache frequency (19.7 days versus 18.2 days per month, p=0.037). The group with a history of abuse was significantly more female (93% versus 86%, p=0.002), achieved a lower education level (p=0.002), were more likely to be divorced, separated, or widowed (p=0.002), were more likely to be disabled from working (p<0.001), and had a lower household income (p<0.001). After controlling for patient age, sex, years lived with headache, headache frequency, and sociodemographic characteristics, a history of abuse was significantly associated with more-severe scores on every migraine-related disability measure evaluated. Though an independent effect of abuse on more-severe migraine disability persisted, psychiatric comorbidity mediated these associations, and the effect of depression was generally greater than that of anxiety.

Conclusions:

A history of abuse is associated with greater migraine-related disability and migraine disease burden. Although the relationship between a history of abuse and migraine-related disability and burden is mediated by anxiety and depression, an independent effect remains.