title: Posttraumatic stress disorder in migraine.
abstract: OBJECTIVE
  To evaluate the relative frequency of posttraumatic stress disorder (PTSD) in episodic migraine (EM) and chronic daily headache (CDH) sufferers and the impact on headache-related disability.
  
  
  BACKGROUND
  Approximately 8% of the population is estimated to have PTSD. Recent studies suggest a higher frequency of PTSD in headache disorders. The association of PTSD and headache-related disability has not been examined.
  
  
  METHODS
  A prospective study was conducted at 6 headache centers. PTSD was assessed using the life events checklist and PTSD checklist, civilian version (PCL-C). We compared data from EM to CDH, and migraine with PTSD to migraine without PTSD. The PHQ-9 was used to assess depression, and headache impact test (HIT-6) to assess disability.
  
  
  RESULTS
  Of 767 participants, 593 fulfilled criteria for EM or CDH and were used in this analysis. The mean age was 42.2 years and 92% were women. The frequency of PTSD was greater in CDH than in EM (30.3% vs 22.4%, P = .043), but not after adjusting for demographics and depression (P = .87). However, participants with major depression and PTSD were more likely to have CDH than EM (24.6% vs 15.79%, P < .002). Disability was greater in migraineurs with PTSD, even after adjustments (65.2 vs 61.7, P = .002).
  
  
  CONCLUSIONS
  The frequency of PTSD in migraineurs, whether episodic or chronic, is higher than the historically reported prevalence of PTSD in the general population. In addition, in the subset of migraineurs with depression, PTSD frequency is greater in CDH sufferers than in episodic migraineurs. Finally, the presence of PTSD is independently associated with greater headache-related disability in migraineurs.
authors.affiliation: Drexel University College of Medicine, Department of Neurology, Philadelphia, PA 19102, USA.
authors.forename: B Lee
authors.initials: BL
authors.lastname: Peterlin
authors.forename: Gretchen E
authors.initials: GE
authors.lastname: Tietjen
authors.forename: Jan L
authors.initials: JL
authors.lastname: Brandes
authors.forename: Susan M
authors.initials: SM
authors.lastname: Rubin
authors.forename: Ellen
authors.initials: E
authors.lastname: Drexler
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Lidicker
authors.forename: Sarah
authors.initials: S
authors.lastname: Meng
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000453:epidemiology*; D011446:Prospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires