PTSD and Abuse and Their Relationship to Migraine

This is never an easy topic to talk about, but it is one which needs to be addressed. Research has shown that sexual, physical and especially emotional abuse creates a predisposition to headache. Individuals with migraine may have experienced abuse in early life. Childhood maltreatment, referred to as “Adverse Childhood Experiences” (ACEs), is associated with an earlier onset of migraine and a tendency for episodic migraine to become chronic. Identification of an abusive history may influence the assessment and treatment of presenting health concerns. Further, providing resources to those being abused can result in improved outcomes.

Being a victim of abuse, or a witness to abuse, is stressful. This is particularly true when one is young, and dependent on one’s family. In some homes, abuse, particularly verbal abuse, is so common that a child may never have experienced a more nurturing environment. In many instances, maltreated children cannot identify a trusted adult in whom to confide. Sometimes children who report abuse are either not believed or are made to feel at fault. It is not difficult to imagine how a stressful early life might lead to depression and anxiety, as well as a lack of confidence.

Stress is the most widely recognized trigger for migraine attacks. For instance, many people report that experiences such as a deadline at work, a fight with a family member, or a sick child at home bring on an attack. But can stress experienced as a child make one more prone to migraines later in life? Although there is not direct proof, there are now more than ten published studies that suggest that persons who report having experienced childhood abuse are considerably more likely to experience headaches in adulthood than those who have had carefree childhoods. Furthermore, the worse the abuse is the higher the likelihood of developing headache, as well as other pain conditions. To further understand how stress causes headache, researchers have studied both the long and short-term effects of stress on body function.

Autonomic nervous system response

Stress may affect the autonomic (or “automatic”) nervous system. This part of the nervous system controls the “fight or flight” response that is the body’s natural response to danger. It is controlled by the hypothalamus, pituitary and adrenal glands. Relaxation therapies can counteract the “fight or flight” response. They engage the parasympathetic branch of the nervous system that controls the “relaxation response.”The relaxation response can often be started through deep breathing or focusing on a pleasant image or memory. Free instructions and audio relaxation exercises are available at dawnbuse.com as well as many apps on iTunes and other sources.

Hormonal changes

Acute stress causes different organs to release a variety of hormones that ultimately lead the release of cortisol, a steroid hormone. Cortisol is produced in the adrenal gland, which sits on top of the kidney, and it is released into the blood stream in response to stress. In the short term, the greater the stress, the higher the levels of cortisol. But with long-term stress experienced by those growing up in an abusive home, cortisol responses may rise and then eventually decline. Over time, lower cortisol levels may also result in chronic inflammation, a state that has been linked to heart disease. Studies have shown that adults experiencing child abuse are more likely to have inflammation and also to experience heart attacks.

Brain changes

MRI studies in adults, even young adults, who have experienced childhood abuse show that there are changes in the brain structures that process what is heard and seen. They connect this information to the structures that have a role in regulating emotions. This network of structures is known as the limbic system. Age at the time of abuse is probably important as different regions of the brain have particular periods when they are most sensitive to the effects of stress. Interestingly, recent studies in adults with migraine show many of the same areas to be affected.

Genetic changes

Research has shown persons carrying certain genes are more susceptible to the effects of early life stress. Even more surprising is new evidence that the stressful experiences turn on and off certain genes and these gene changes (called epigenetics) may persist and have an effect on health later in life. It is also possible that these changes could actually be passed on to the next generation.

Treatment of History of Abuse and PTSD

Cognitive behavioral therapies (CBT) have the best evidence for treating the effects of abuse. CBT can be helpful both during and immediately following a traumatic experience, or years later, to help one cope with the after effects. CBT can be used in adults, children, elderly, or disabled persons. There are several subtypes of CBT with scientific data supporting their use for PTSD. Cognitive therapy involves identifying and managing distressing trauma-related thoughts and abnormal patterns of thinking. Exposure therapy involves reducing the fear associated with traumatic experiences. This occurs through repeated confrontation combined with relaxation. This can be for feared places, situations, memories, thoughts and feelings.

Stress inoculation therapy involves developing skills for managing stress and anxiety. Types of skills include deep breathing, muscle relaxation, assertiveness training, role-playing, thought stopping and positive thinking. In eye movement desensitization and resensitization (EMDR) therapy, a person focuses on emotionally disturbing material. At the same time they focus on an external stimulus. This is usually eye movements, hand tapping, or sounds. For people who struggle with self-harm behaviors, dialectic behavior therapy (DBT) is especially helpful. Behaviors include self-cutting or suicidal thoughts or actions. DBT is also useful for those making dangerous or unhealthy life choices. DBT combines the basic principles of CBT with relaxation training, mindfulness mediation, and other proven interventions. For help finding a mental health provider who uses these therapies see the recommendations below. For more information about psychological and behavioral treatments for survivors of abuse and PTSD see: Association for Behavioral and Cognitive Therapies (ABCT): www.abct.org. In addition, everyone can benefit from learning and practicing relaxation techniques such as deep breathing, meditation and visual imagery.

The role of medication for the treatment of PTSD is less firmly proven. Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of antidepressant medications. They are often prescribed for PTSD, but there is debate over their benefit. Studies in animals suggest that treatment with SSRIs may actually reverse some of the effects of maltreatment on the stress response. Other medications currently being investigated for the treatment of PTSD include beta-blockers (e.g. propranolol), Prazocin and Ketamine. It is not recommended to take benzodiazepines, such as Valium, Ativan or Xanax, because they are not effective in treating PTSD and can be addictive.

Talking to a mental health professional such as a psychologist, psychiatrist, or licensed clinical social worker, speaking to an abuse advocate, or calling an abuse hotline may help you cope, and put you in the right direction toward healing. From a perspective of treating your headache, therapies help with stress management may be beneficial such as biofeedback and relaxation training. Most importantly, do not be ashamed or embarrassed to ask for help. You are not alone. Help is available.

Domestic Violence Resources:

National Domestic Violence Hotline: Tel: 1-800-799-SAFE (7233) or TTY 1-800-787-3224 or visit their website at ndvh.org
National Sexual Assault Hotline: Tel: 1-800-656-4673 or visit their website at rainn.org
Futures without Violence: visit their website at futureswithoutviolence.org/section/_get_help or call 1-800-799-SAFE (7233)
National Clearinghouse on Abuse in Later Life:ncall.us/
National Organization for Victim Assistance (NOVA)Tel: 1-800-879-6682 or visit their website at trynova.org
National Resource Center on Domestic Violence
Manweb, a website with information for battered men: batteredmen.com
Child Welfare Information Gateway: childwelfare.gov/responding/reporting.cfm
National Center on Elder Abuse: Tel: 302-831-3525 or visit their website at ncea.aoa.gov

To find a mental healthcare professional and/or learn more about Cognitive Behavioral Therapies and other treatments for survivors of abuse and PTSD, visit:

American Psychological Association (APA): apa.org
Association for Behavioral and Cognitive Therapies (ABCT): abct.org

Source: https://americanmigrainefoundation.org/resource-library/abuse-maltreatment-and-ptsd-and-their-relationship-to-migraine/