The prevalence of physical and sexual abuse in our population of

The prevalence of physical and sexual abuse in our population of men and women with migraine is similar to that reported in the literature for clinic and community populations4,30 and to what we reported in an earlier study in a female migraine clinic population.22 We found, however, that the prevalence of

emotional abuse in our population was substantially higher than in other clinic-based30 and community studies,4 and more prevalent in women, as has been previously reported.4 Multicategory abuse was common; of the 58% of participants reporting any childhood maltreatment, 40% reported experiencing at least 2 types of maltreatment. The overlap of physical and sexual abuse was considerably higher than in a population sample with face-to-face interview using a different survey tool,31 and was most often associated with emotional maltreatment. All Neratinib clinical trial childhood maltreatment types are linked to revictimization in adulthood, predominantly under the age of 30 years. The nature of the relationship between childhood abuse and adult migraine remains speculative. One hypothesis is that abuse predisposes to

conditions that in turn influence migraine prevalence. Without a non-headache control group, our study cannot support or refute a relationship of headache H 89 and abuse. However, similar to reports from large general population-based studies,7-10,13 we identified a number of factors associated with a history of childhood maltreatment in migraineurs, including lower educational status, obesity,

substance abuse, depression, and anxiety. These factors have also been associated with migraine, particularly chronic migraine.32,33 Our finding that in a migraine population, all types of maltreatment are associated with major depression and anxiety Methocarbamol raises the possibility that psychiatric illness mediates the link of maltreatment and migraine. Another hypothesis is that abuse independently impacts migraine. A recent population study of over 32,000 adolescents found that in the migraine subjects without a strong genetic predisposition, low household income was a marker of increased prevalence, suggesting a role for environmental risk factors.34 It is well established that abuse is more prevalent in low-income households.1,2 The social causation theory is strengthened by the vast scientific work being conducted on the neurobiological effects of early maltreatment, which range from neurohumoral to structural and functional.35-37 The evaluation and diagnosis by headache specialists according to ICHD-2 criteria is a strength of this study. The geographic diversity and inclusion of both men and women allows some generalization to other headache clinic populations.

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