Adverse Childhood Experiences and Primary Headache Disorders

Abstract

Background and Objectives:Headache disorders are among the leading causes of disability worldwide. While an association between adverse childhood experiences and primary headaches has been reported, the pooled magnitude across studies and pathways of the association are unknown. Our objectives were 1) to estimate the pooled effect of ≥1 adverse childhood experience (ACE) on primary headache disorders in adulthood, and 2) test the hypothesis that ACEs categorized as “threat” or “deprivation” have distinct impacts on primary headaches based on a selected theory from our narrative review of how ACEs impact development along the life course.Methods:PubMed, EMBASE, Medline, Web of Science, Google Scholar, Biological Psychiatry, and grey literature were searched up to Mar 16, 2023 (PROSPERO, CRD42020223403). Selected articles included: 1) observational studies with a comparator group, 2) ACEs that occurred before age 18, and 3) primary headaches, occurring ≥21 years of age. Pooled odds ratios (ORs) were calculated using a multilevel linear random-effects model. The narrative review included theories that describe how ACEs impact human development and disease across the life course. We selected a theory from our narrative review and tested ACEs categorized according to this theory for any modification of point estimates.Results:Our search identified 32 studies, of which 28 were eligible for meta-analysis (n = 154,739 participants, 19 countries). The occurrence of ≥1 adverse childhood experience(s) was associated with primary headaches [pooled OR = 1.48 (95% CI 1.36-1.61); high-quality evidence, 134,696 participants]. As the number of ACEs increased, the odds of primary headaches increased [Range: 1 ACE OR = 1.24 (95% CI 1.14-1.35) to ≥4 ACEs OR= 2.09 (1.83-2.38), p-value for trend <0.0001]. From the narrative review, a neurodevelopmental theory that categorizes ACEs into threat or deprivation was tested and both were independently associated with primary headaches [threat OR=1.46 (95% CI: 1.32-1.60) and deprivation OR=1.35 (95% CI: 1.23-1.49), respectively], accounting for heterogeneity (p = 0.021).Discussion:This systematic review and meta-analysis confirm that ACEs are important risk factors for primary headache disorders in adulthood. Our findings provide epidemiological support that ACEs categorized as threat and deprivation may manifest as distinct pathways of early adversity.

Perceived association of mood and symptom severity in adults with mitochondrial diseases

“…High ACE scores were also associated with more frequent emergency visits and hospitalizations (Diaz et al, 2022; Okeson et al, 2022). Similarly, a meta-analysis including >150,000 adult participants showed that as the number of reported ACEs increased, the risk of primary headaches significantly increased, with both threat and deprivation traumas being associated with headache disorders (Sikorski et al, 2023), consistent with an effect of psychological factors on physical health. To our knowledge, whether psychosocial processes are associated with symptom severity in mitochondrial diseases has not been examined.…”

Approach to the Patient With Headache

“…It is particularly important to ask about current or previous physical, emotional, and sexual abuse. Migraine and tension-type headache are more prevalent in individuals with recalled childhood maltreatment, particularly in sexual and gender minority adults, often associated with coexisting anxiety, depression, and posttraumatic stress disorder 62,63 . This author includes a question on the new patient intake form regarding a history of physical, emotional, or sexual abuse and addresses it during the patient interview after confirming that the patient feels comfortable discussing it.…”

From Hard Knocks to Headache

“…5 Twelve years hence, a meta-analysis of 5 general population studies with 7,500 persons corroborated the initial report by demonstrating that sexual assault, particularly in childhood, was associated with a 2-fold increased odds of headache. 6 In this issue of Neurology ®, Sikorski C, et al 7 describe the first meta-analysis of the relationship of primary headache and ACEs since the 1999 publication. As such, it is an important contribution to a greatly expanded literature on this association.…”