Childhood Abuse in Pediatric Patients With Chronic Daily Headache

Abstract

Recent studies have raised significant concern about the high prevalence of childhood abuse in adults with chronic daily headache (CDH). In a survey of 1348 adult migraine patients,1 it was found that 21% of patients reported a history of childhood physical abuse and 25% reported a history of sexual abuse. Data from the ACE (Adverse Childhood Experiences) study and other studies have also found that childhood physical abuse and other forms of maltreatment were significantly associated with migraine headache.2–4 Although retrospective studies seem to provide strong evidence for an association between childhood abuse and CDH, one prospective longitudinal study did not find a difference between those with and without a documented history of childhood abuse in terms of their risk for chronic pain in adulthood.2 These inconsistent results may be a result of varying methodologies, the effects of recall bias or because the connection between childhood abuse and pain in adulthood may be more complex. More prospective research is needed to investigate the connection between childhood abuse and CDH. Children with CDH form a significant proportion of patients seen in pediatric neurology clinics, accounting for up to one third of newly referred patients.5 There is little research examining the prevalence of childhood physical and sexual abuse in pediatric headache patients, and the impact of an early abuse history in terms of clinical presentation of pediatric CDH patients (headache frequency, severity, disability, and quality of life) is not known. As part of the screening process for a large treatment study for pediatric CDH, our research team gathered comprehensive clinical data, including data on exposure to trauma among the patients. The objectives of this investigation were to 1) specifically examine the prevalence of physical and sexual abuse in these clinically referred children and adolescents with CDH and 2) to compare headache characteristics, headache-related disability, depressive symptoms, and quality of life between those who reported a history of abuse and those who did not. Based on the adult literature, we hypothesized that we would find a higher rate of childhood abuse in CDH than in the general population and a rate similar to what has been reported in the adult literature (ie, approximately 20%). Also, we hypothesized that CDH patients with a positive history of abuse would have higher levels of headache-related disability, more depressive symptoms, and lower quality of life than those without a history of abuse.