Adverse Childhood Experiences Are Associated With Risk for Migraine Later in Life
Dr. Buse also discussed the sympathetic nervous activation or “fight-or-flight response,” an instinctual, natural, functional response to physical danger. “However, most of our stress in life is more emotional or cognitive than physical,” she noted. “Patients who have been exposed to traumatic events may experience a state of chronic activation of the sympathetic nervous system, which may manifest itself in generalized anxiety disorder and panic attacks.” She recommended teaching patients to engage in relaxation therapies that activate the parasympathetic nervous system and calm the sympathetic nervous system.
Dr. Buse said that the cognitive behavioral therapies she uses have the strongest evidence for treatment and management of PTSD. Cognitive therapy helps individuals identify and change maladaptive patterns of thinking. Cognitive behavioral therapy includes teaching patients to make healthy lifestyle changes and practicing relaxation techniques (ie, diaphragmatic breathing, visual imagery, or meditation). “It is not uncommon for persons who have been victims of abuse to engage in self-harm behaviors such as cutting,” Dr. Buse noted. “One of the goals of cognitive behavioral therapy is teaching patients effective and healthy responses to stress and trauma including relaxation or engaging in alternative behaviors.” She provided a case example of a patient who engages in art therapy and cognitive restructuring exercises when she feels the urge to cut herself. She reported that there is also some evidence for benefits of pharmacotherapy for the treatment of PTSD.
Treating Migraine Patients With Histories of Abuse
“Being exposed to these events changes us in biologic ways, which not only disposes us to migraine, but to many other conditions,” Dr. Buse stated. The first step in treating these patients, she suggested, is looking for signs and asking about any history of childhood or current abuse. “It is not uncommon for persons who were mistreated as children to be abused as adults. Victims of abuse can be any age, gender, or ethnicity, and perpetrators of abuse can also be any age, gender, or ethnicity.”
After assessing the patient’s condition, a physician may make a referral to a mental health provider. “When I make a referral, I like to use the phrases ‘biobehavioral training’ or ‘behavioral medicine,’” Dr. Buse said. “Make it clear that you are still treating their headaches and are not abandoning them, but … also addressing the horrible experiences they’ve gone through with a mental health care provider who has experience in working with victims of abuse and PTSD will most likely help improve their life and might even make their headaches better.”
Dr. Buse also emphasized the importance of informing patients that headache and migraine are comorbidities of childhood abuse and trauma. “Educate your patients—let them know that abuse is common. They should not be ashamed or feel guilty, although they may feel that way,” she said. “Let them know that there are treatments, and let them know that seeking psychologic treatments or therapy for these conditions may also help with headache. Most importantly, let them know that they are not alone. Sadly, abuse is not uncommon, but effective treatments are available.”
