LOS ANGELES(EGMN) –Adults with migraines who also had cardiovascular risk factors were 39%-83% more likely to report having been abused or neglected as children compared with migraineurs without cardiovascular problems in a study of 1,348 patients.

In addition, a linear relationship was found between the risk of stroke/transient ischemic attack (TIA), myocardial infarction, or both and the total number of types of abuse reported by patients, Dr. Gretchen E. Tietjen reported at the meeting.

“This certainly suggests that childhood maltreatment may adversely influence cardiovascular status—both disease and risk factors—in adulthood,” she said.

Previous studies have identified associations between childhood maltreatment and adult morbidities, including cardiovascular disease. But this is the first study to look at those associations in migraineurs.

Headache specialists determined the migraine diagnosis and attack frequency for the patients at 11 U.S. and Canadian headache centers. Patients reported whether they had been told by a physician that they have cardiovascular disease, specific cardiovascular risk factors, or other comorbidities while completing a self-administered electronic questionnaire, which included the Childhood Trauma Questionnaire to identify childhood maltreatment.

One or more cardiovascular risk factors was reported by 71% of patients, including hypertension, hyperlipidemia, obesity, obstructive sleep apnea, or ever having smoked. A small percentage of patients reported a history of stroke, TIA (5%), or prior MI (4%).

The questionnaire asked about physical, sexual, or emotional abuse and about physical or emotional neglect. Migraineurs with cardiovascular disease were more likely to report childhood abuse rather than less-severe neglect, compared with migraineurs without cardiovascular disease, reported Dr. Tietjen and her associates in the American Headache Society’s Women’s Issues Research Consortium.

Patients with one or more cardiovascular risk factors said they had experienced more types of abuse as children compared with migraineurs without cardiovascular risk factors, said Dr. Tietjen, professor and chair of neurology at the University of Toledo, Ohio. (See chart.)

Because the analysis was controlled for age, race, gender, income, education, and each of the other individual risk factors, “those are pretty significant differences,” she said. “I certainly think that abuse is related to migraine in some way, but how well it fits in” remains to be determined in future studies of better databases.

“I’d really like to look at young people –people who are in the 18-to-24 range, where maybe migraine is all they have. But if they have a history of abuse it may mean that they are predisposed to develop some of these other conditions,” Dr. Tietjen said in an interview at the meeting. Cognitive-behavioral therapy might help these young people change their response to stressful stimuli. “If you can change their response to stress, maybe they’d be less likely to develop some of these other conditions,” she said.

A separate analysis of the study’s data identified three constellations of comorbidities in migraineurs with distinct demographic, headache, and psychosocial profiles, Dr. Tietjen reported in a separate presentation at the meeting.

One group of 231 patients reported a relative absence of comorbid conditions. Another 669 patients fit into a group of “pain conditions,” including irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, interstitial cystitis, uterine fibroids, and arthritis. The remaining 448 patients were grouped in “metabolic and psychiatric conditions,” including hypertension, diabetes, hyperlipidemia, depression, and anxiety.

Compared with the group without comorbidities, those in the pain and metabolic/psychiatric groups were older, more likely to be white, had more headaches per month, were more likely to have chronic migraine, and had higher disability scores on the six-item Headache Impact Test.

The two comorbidity groups were associated with a doubling or tripling in risk for childhood maltreatment, especially emotional abuse, in an adjusted logistic regression analysis, Dr. Tietjen said.

Patients in the pain or metabolic/psychiatric comorbidity groups were three times as likely as the no-comorbidity group to report childhood emotional abuse or emotional neglect and twice as likely to report physical or sexual abuse. Reports of physical neglect were twice as likely in the pain group and three times as likely in the metabolic/psychiatric group, compared with the control group.

“Our data suggest that environmental factors as well as genetic factors may influence migraine comorbidity groupings,” she said.

Adverse childhood experiences were associated with increased risk for frequent headaches in a dose-response fashion in a separate analysis of data on 17,337 adult members of Kaiser Health Plan in San Diego who were undergoing a comprehensive preventive medical evaluation, Dr. Tietjen reported in a poster presentation at the meeting.

The risk for frequent headaches was 60% higher in patients who reported childhood emotional abuse, 40% higher in those who reported physical abuse, 30% higher in those who reported sexual abuse, witnessed domestic violence, or reported mental illness in the household, 20% higher in patients who reported substance abuse in the household of who had a household member imprisoned; and 10% higher in those who experienced parental separation or divorce.

In comparison with patients without adverse experiences, the headache frequency of patients rose significantly for each increase in the number of types of adverse experiences that thy reported. The relative risk for frequent headache increased by 20%, 40%, 70%, and 100% as the number of types of adverse childhood experiences reported by the patients rose from one, two, three, and four or more, respectively.

Future studies of general populations with headache should carefully classify them by headache criteria, Dr. Tietjen and her associates suggested. A better understanding of the link between adverse childhood experiences and migraine might improve understanding of the pathophysiology and lead to better therapies, she said.

Dr. Tietjen has received research grants from GlaxoSmithKline, and consulting fees and honoraria from MAP Pharmaceuticals.

Copyright (c) 2010 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

洛杉矶(EGMN)—— 一项纳入了1,348例患者的研究表明，在具有心血管危险因素的偏头痛成年患者中，诉童年时期曾遭虐待或忽视的患者比例比那些没有心血管问题的偏头痛患者高39%~83%。

 

会上，Gretchen E. Tietjen博士还报告称，而且，偏头痛患者出现卒中/一过性脑缺血发作(TIA)、心肌梗死(MI)或两者兼有的风险与患者所诉受虐类型的总数之间存在线性关系。

 

Tietjen博士说：“显然，这表明童年期受虐史可能会对其成年后的心血管状况产生负面影响，既包括心血管疾病也包括心血管危险因素。”

 

先前开展的研究已经证实，童年期受虐与成年后患病(包括心血管疾病)相关。但在偏头痛患者中评价这种相关性尚属首次。

 

对于来自美国和加拿大11家头痛中心的患者，由头痛专科医生来确定偏头痛的诊断及发作频率。患者自行填写一份电子问卷，诉其是否曾被医生告知患有心血管疾病、存在某种特定的心血管危险因素或其他合并症。其中还包括一份童年期创伤问卷，以确定是否存在童年期受虐史。

 

71%的患者称其存在1种或多种心血管危险因素，包括高血压、高血脂、肥胖、阻塞性睡眠呼吸暂停或吸烟史。小部分患者称其既往有过卒中、TIA(5%)或MI (4%)病史。

 

美国头痛学会女性问题研究联盟的Tietjen博士及其同事报告称，问卷从身体虐待、性虐待、情感虐待以及身体忽视或情感忽视等多方面进行了解。在患有心血管疾病的偏头痛患者中，诉童年期曾遭虐待(而非情节相对较轻的忽视)的患者比例高于那些没有心血管疾病的偏头痛患者。

 

美国俄亥俄州托莱多大学的神经病学教授兼系主任Tietjen博士说，存在1种或多种心血管危险因素的患者所诉童年期曾遭遇的虐待类型多于那些不存在心血管危险因素的偏头痛患者(See chart.)

 

Tietjen博士说，由于这项分析经过了年龄、种族、性别、收入、受教育程度以及其他每一种危险因素的校正，所以“具有非常显著的统计学差异”。“我当然认为受虐史通过某种途径与偏头痛相关，但这种相关性到底有多大”仍需基于更加全面的数据库开展进一步的研究才能确定。

 

Tietjen博士在会议采访中说：“事实上我很想对18至24岁年龄段的年轻人进行分析，这个时期他们可能只患有偏头痛。但如果他们有受虐史，这可能意味着他们更容易出现部分其他疾病。”认知行为治疗可能有助于这些年轻人改变其对压力刺激的反应。Tietjen博士说：“如果能够改变其对压力的反应，那么他们出现部分其他疾病的可能性或许会降低。”

 

Tietjen博士在会上的另一次发言中称，基于这项研究数据的另一项单独分析表明，根据偏头痛患者的合并症类型将其分为3大类，每一类患者都有着各自不同的人口统计学、头痛和社会心理特征。

 

第一组由231例合并症相对缺失的患者组成。另外669例患者则被纳入“疼痛病症”组，包括肠易激综合征、慢性疲劳综合征、纤维肌痛、间质性膀胱炎、子宫肌瘤和关节炎。其余448例患者则被归为“代谢及精神病症”组，包括高血压、糖尿病、高血脂、抑郁和焦虑。

 

与没有合并症的一组相比，疼痛组以及代谢/精神组的患者年龄更大、白种人的比例更高、每个月头痛的发作次数更多、出现慢性偏头痛的几率更大，并且6项头痛影响测验示残疾评分更高。

 

Tietjen博士说，校正后的Logistic回归分析显示，后两组与童年期受虐风险增加1倍或2倍相关，尤其是情感虐待。

 

在疼痛合并症组或代谢/精神合并症组中，诉童年期曾遭情感虐待或情感忽视的患者比例是无合并症组的3倍，诉童年期曾遭身体虐待或性虐待的患者比例是无合并症组的2倍。疼痛组和代谢/精神组诉曾遭身体忽视的患者比例分别是对照组的2倍和3倍。

 

Tietjen博士说：“我们的研究数据表明，环境因素以及遗传因素可能影响到偏头痛合并症的分类。”

 

Tietjen博士在会上的一份壁报中称，另一项针对参与了圣地亚哥Kaiser健康计划且正在接受全面的预防医学评价的17,337名成年人数据的分析表明，童年时期的不良经历与频发头痛的风险增加相关，并且这种经历越多，风险就越高。

 

与没有不良经历的患者相比，诉童年期曾遭情感虐待的患者频发头痛的风险增加了60%，诉曾遭身体虐待的患者风险增加了40%，诉曾遭性虐待、目睹过家庭暴力或有家人患有精神疾病的患者风险增加了30%，诉有家人存在物质虐待或有家人被监禁的患者风险增加了20%，经历过父母分居或离异的患者风险增加了10%。

 

与没有不良经历的患者相比，患者所诉不良经历的类型越多，头痛的发作频率就越高，每增加一类经历，差异都有统计学意义。患者所诉童年期不良经历的类型为1种、2种、3种、4种或4种以上，那么频发头痛的相对风险分别增加20%、40%、70%和100%。

 

Tietjen博士及其同事建议，将来基于普通头痛人群的研究应该根据头痛标准进行仔细分类。Tietjen博士说，进一步认识童年期不良经历与偏头痛之间的相关性可能有助于完善我们对头痛病理生理学的认识并改进头痛的治疗。

 

Tietjen博士声明接受了葛兰素史克提供的研究经费，以及MAP制药公司提供的顾问费和酬金。

 

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