TOPLINE:
Childhood trauma increases the risk of developing a primary headache disorder in adulthood, with more early adverse experiences raising the risk even more, a new study found.
METHODOLOGY:
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The meta-analysis included 28 observational studies with 154,739 persons in 19 countries that assessed the relationship between at least one adverse childhood experience (ACE) and primary headache (including migraine, tension-type headache, cluster headache, and chronic/severe headache) at age 21 years or older.
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From each study, researchers extracted outcome point estimates and corresponding 95% CIs, number of events in each group, and covariates included in the model. They subcategorized ACEs according to those involving threat (eg, physical, emotional, or sexual abuse) and deprivation (eg, neglect, household substance misuse).
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For the primary analysis, the researchers calculated the odds ratios (ORs) and hazard ratios (HRs) of headache among persons with at least one ACE compared with those with no ACEs.
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They also tested an underlying biological theory that threat and deprivation ACEs may manifest differently in neurodevelopment, with distinct impacts on primary headaches.
TAKEAWAY:
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The most commonly reported ACEs were physical abuse (77%), sexual abuse (73%), and exposure to family violence (38%).
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Compared with having experienced no ACEs, experiencing at least one was associated with primary headaches (pooled OR, 1.48; 95% CI, 1.36-1.61).
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As the number of ACEs increased, the strength of the association with primary headaches increased in a dose-response relationship (P for trend < .0001).
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Both threat and deprivation were independently associated with primary headaches; the pooled main effect was consistent for threat (OR, 1.46; 95% CI, 1.32-1.60) and for deprivation (OR, 1.35; 95% CI, 1.23-1.49), suggesting possible distinct pathways of early adversity.
IN PRACTICE:
Clinicians who treat primary headaches in adults “should routinely screen for ACEs, educate patients on the connection between ACEs and health, and provide referrals for treatment strategies,” the investigators write. Strategies such as trauma-informed or attachment-based therapy may help rewire parts of the brain that have been dysregulated, they add.
SOURCE:
The study was led by Claudia Sikorski, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. It was published online October 25 in Neurology.
LIMITATIONS:
The findings reflect a conservative estimate of the true impact of ACEs on primary headaches, because ACEs are commonly underreported. The analysis could not statistically disentangle younger adults with developing brains (age 21-26 years) from older adults. Not all included studies adjusted for age and sex, which are known risk factors for headaches. The study did not explore the relationship between ACEs and primary headache disorders in childhood and adolescence. Owing to the inherent nature of studies investigating ACEs, causation cannot be inferred.
DISCLOSURES:
The authors report no targeted funding and no relevant conflicts of interest.
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