Adverse childhood experiences and frequent headaches in adults.
BACKGROUND
A variety of studies have linked childhood maltreatment to headaches, including migraines, and to headache severity. This study assesses the relationship of adverse childhood experiences (ACEs) to frequent headaches during adulthood.


METHODS
We used data from the Adverse Childhood Experiences (ACE) study, which included 17,337 adult members of the Kaiser Health Plan in San Diego, CA who were undergoing a comprehensive preventive medical evaluation. The study assessed 8 ACEs including abuse (emotional, physical, sexual), witnessing domestic violence, growing up with mentally ill, substance abusing, or criminal household members, and parental separation or divorce. Our measure of headaches came from the medical review of systems using the question: "Are you troubled by frequent headaches?" We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a "dose-response" relationship of the ACE score to the prevalence and risk of frequent headaches.


RESULTS
Each of the ACEs was associated with an increased prevalence and risk of frequent headaches. As the ACE score increased the prevalence and risk of frequent headaches increased in a "dose-response" fashion. The risk of frequent headaches increased more than 2-fold (odds ratio 2.1, 95% confidence interval 1.8-2.4) in persons with an ACE score ≥5, compared to persons with and ACE score of 0. The dose-response relationship of the ACE score to frequent headaches was seen for both men and women.


CONCLUSIONS
The number of ACEs showed a graded relationship to frequent headaches in adults. Future studies should examine general populations with headache, and carefully classify them. A better understanding of the link between ACEs and migraine may lead to new knowledge regarding pathophysiology and enhanced additional therapies for headache patients.
Anda
Robert
R
Carter Consulting Inc., Atlanta, GA, USA.
Tietjen
Gretchen
G
Schulman
Elliott
E
Felitti
Vincent
V
Croft
Janet
J
D000328:Adult; D002648:Child; D002649:Child Abuse / Q000145:classification / Q000401:mortality* / Q000523:psychology*; D015897:Comorbidity; D005260:Female; D051271:Headache Disorders, Secondary / Q000145:classification / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards; D015995:Prevalence; D013995:Time