title: History of childhood maltreatment is associated with comorbid depression in women with migraine.
abstract: BACKGROUND
  A bidirectional relationship between migraine and depression suggests a neurobiological link. Adverse experiences, particularly childhood maltreatment, may alter neurobiological systems, and predispose to a multiplicity of adult chronic disorders. Our objective is to determine, within a headache clinic population of women, if depression moderates the abuse-migraine relationship.
  
  
  METHODS
  At six headache specialty clinics, women with migraine were diagnosed using ICHD-II criteria, and frequency was recorded. A questionnaire regarding maltreatment history, headache characteristics, current depression, and somatic symptoms was completed.
  
  
  RESULTS
  A total of 949 women with migraine completed the survey: 40% had chronic headache (> or =15 headache days/month) and 72% had "very severe" headache-related disability. Major depression was recorded in 18%. Physical or sexual abuse was reported in 38%, and 12% reported both physical and sexual abuse in the past. Migraineurs with current major depression reported physical (p < 0.001) and sexual (p < 0.001) abuse in higher frequencies compared to those without depression. Women with major depression were more likely to report sexual abuse occurring before age 12 years (OR = 2.30, 95% CI: 1.14 to 4.77), and the relationship was stronger when abuse occurred both before and after age 12 years (OR = 5.08, 95% CI: 2.15 to 11.99). Women with major depression were also twice as likely to report multiple types of maltreatment (OR = 2.07, 95% CI: 1.27 to 3.35) compared to those without depression.
  
  
  CONCLUSIONS
  Childhood maltreatment was more common in women with migraine and concomitant major depression than in those with migraine alone. The association of childhood sexual abuse with migraine and depression is amplified if abuse also occurs at a later age.
authors.affiliation: Department of Neurology, College of Medicine, The University of Toledo-Health Science Campus, Toledo, OH 43614, USA. gretchen.tietjen@utoledo.edu
authors.forename: G E
authors.initials: GE
authors.lastname: Tietjen
authors.forename: J L
authors.initials: JL
authors.lastname: Brandes
authors.forename: K B
authors.initials: KB
authors.lastname: Digre
authors.forename: S
authors.initials: S
authors.lastname: Baggaley
authors.forename: V T
authors.initials: VT
authors.lastname: Martin
authors.forename: A
authors.initials: A
authors.lastname: Recober
authors.forename: L O
authors.initials: LO
authors.lastname: Geweke
authors.forename: F
authors.initials: F
authors.lastname: Hafeez
authors.forename: S K
authors.initials: SK
authors.lastname: Aurora
authors.forename: N A
authors.initials: NA
authors.lastname: Herial
authors.forename: C
authors.initials: C
authors.lastname: Utley
authors.forename: S A
authors.initials: SA
authors.lastname: Khuder
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology*