Abuse and Maltreatment: Their Effect on Headache

Research has shown that sexual, physical, and especially emotional abuse create a predisposition to headache. Individuals with migraine may have experienced abuse in early life. Childhood maltreatment is associated with an earlier onset of migraine and a tendency for episodic migraine eventually to become chronic.

How Would You Define Abuse?

Physical abuse includes slapping, hitting, kicking, striking, pinching or pushing another. Emotional abuse includes neglect, threats, harassment, controlling behavior, attempts to isolate, and bullying. Sexual abuse is any nonconsensual sexual activity. For children and adolescents, it also includes any sexual activity with an older individual, whether consensual or not.

Tell your Physician About Your Abuse

In assessing your health concerns and planning your course of care, it is beneficial for your health-care provider to know if you are currently being abused, feel in danger of being abused, or have been abused in the distant past. If the topic of abuse is not openly addressed, the consequences can include failure of medical treatment and a continued cycle of abuse and poor physical and emotional health.

Is the History of Abuse Important Even if it Occurred as a Child?

As it may be linked to many medical and psychological problems, early abuse is indeed important. Significant stress occurring early in life may lead to an exaggerated response to stress later in life. For some, stress is the most important trigger for migraine. Migraine may also be aggravated by the depression and anxiety that so often follow abuse.

What If I Am Currently Being Abused?

Your health-care providers can guide you to resources offering psychological support and, when needed, personal safety. A sampling of the resources available is listed in the following. If you are currently in danger, ask for help. Place these calls from a phone where you will safe from your abuser. If your children are being abused, inform your health-care team so that this can be reported to the authorities.

How Can I Best Deal With My Abuse?

If you attempt to “forget” about prior abuse or deny that it ever happened, you are not dealing with the problem, but rather ignoring it. Talking to a counselor, speaking to an abuse advocate, or calling an abuse hotline may help you deal cope more effectively. From a perspective of treating your headache, therapies that help with stress management may be beneficial.

Are Resources Available?

Patient Resources

• National Domestic Violence Hotline Tel: 1-800-799-SAFE (7233) or TTY 1-800-787- 3224, visit their web site at http://www. ndvh.org

• National Sexual Assault Hotline Tel: 1-800- 656-4673, visit their web site at http://www. rainn.org

• Futures without Violence: http://www. futureswithoutviolence.org/section/_get_ help 1-800-799-SAFE (7233)

• National Clearinghouse on Child Abuse and Neglect Information http://nccanch.acf.hhs.gov

• National Clearinghouse on Abuse in Later Life http://www.ncall.us/

• National Organization for Victim Assistance (NOVA) http://www.trynova.org Tel: 1-800- 879-6682

• National Resource Center on Domestic Violence

• Manweb: a website with information for battered men. http://www.batteredmen.com.

• Child Welfare Information Gateway: http://www. childwelfare.gov/responding/reporting.cfm

• National Center on Elder Abuse: http:// www.ncea.aoa.gov, Tel: 302-831-3525

Elliott A. Schulman, MD

Professor, Lankenau Institute for Medical Research,

Wynnewood, PA and Adjunct

Clinical Professor of Neurology,

Jefferson School of Medicine