Tietjen Gretchen E, Buse Dawn C, Fanning Kristina M, Serrano Daniel, Reed Michael L, Lipton Richard B
From the Department of Neurology (G.E.T.), University of Toledo, OH; Department of Neurology (D.C.B., R.B.L.), Albert Einstein College of Medicine, Bronx; Montefiore Headache Center (D.C.B., R.B.L.), Bronx, NY; and Vedanta Research (K.M.F., D.S., M.L.R.), Chapel Hill, NC.
Neurology. 2015 Jan 13;84(2):132-40. doi: 10.1212/WNL.0000000000001120. Epub 2014 Dec 24.
To examine the relationship of recalled adverse childhood experiences (ACEs) with migraine and episodic tension-type headache (ETTH).
We conducted a cross-sectional analysis of ACEs among 2007 American Migraine Prevalence and Prevention Study survey respondents with ETTH and migraine. We modeled headache type using logistic regression adjusting for sociodemographic variables (age, race, sex, income), depression, and anxiety, and headache day frequency using ordinal logistic regression with a proportional odds model.
Participants had migraine (n = 8,305) or ETTH (n = 1,429). Rates of ACEs were significantly higher among respondents with migraine than ETTH for emotional neglect (24.5% vs 21.5%), emotional abuse (22.5% vs 16.7%), and sexual abuse (17.7% vs 13.3%). Odds of migraine vs ETTH were significantly higher for those reporting emotional neglect (odds ratio [OR] = 1.23, 95% confidence interval [CI] 1.07-1.42), emotional abuse (OR = 1.46, 95% CI 1.25-1.71), or sexual abuse (OR = 1.35, 95% CI 1.11-1.62) when adjusted for sociodemographics. Results remained significant only for emotional abuse when adjusting for depression and anxiety (OR = 1.33, 95% CI 1.13-1.57). Odds of migraine were higher with 2 (OR 1.52, 95% CI 1.25-1.86) vs 1 (OR 1.17, 95% CI 1.00-1.36) ACE, which held after adjusting for depression and anxiety. All forms of maltreatment were associated with higher headache day frequency category in migraine but results lost significance after adjusting for depression and anxiety.
ACEs are associated with a higher risk of migraine vs ETTH. Attenuation of the influence of ACEs by depression and anxiety suggests confounding or mediation, although results for emotional abuse were generally maintained.
研究回忆起的童年不良经历（ACEs）与偏头痛和发作性紧张型头痛（ETTH）之间的关系。
我们对2007年美国偏头痛患病率与预防研究中患有ETTH和偏头痛的调查对象的ACEs进行了横断面分析。我们使用逻辑回归对社会人口统计学变量（年龄、种族、性别、收入）、抑郁和焦虑进行调整，以对头痛类型进行建模，并使用比例优势模型的有序逻辑回归对头痛日频率进行建模。
参与者患有偏头痛（n = 8305）或ETTH（n = 1429）。在情感忽视（24.5%对21.5%）、情感虐待（22.5%对16.7%）和性虐待（17.7%对13.3%）方面，偏头痛患者中ACEs的发生率显著高于ETTH患者。在对社会人口统计学进行调整后，报告情感忽视（优势比[OR]=1.23，95%置信区间[CI]1.07 - 1.42）、情感虐待（OR = 1.46，95%CI 1.25 - 1.71）或性虐待（OR = 1.35，95%CI 1.11 - 1.62）的患者患偏头痛的几率显著高于ETTH患者。在对抑郁和焦虑进行调整后，仅情感虐待的结果仍具有显著性（OR = 1.33，95%CI 1.13 - 1.57）。有2种ACEs的偏头痛几率（OR 1.52，95%CI 1.25 - 1.86）高于有1种ACEs的情况（OR 1.17，95%CI 1.00 - 1.36），在对抑郁和焦虑进行调整后依然如此。所有形式的虐待都与偏头痛中更高的头痛日频率类别相关，但在对抑郁和焦虑进行调整后结果失去显著性。
与ETTH相比，ACEs与偏头痛的风险更高相关。抑郁和焦虑对ACEs影响的减弱表明存在混杂或中介作用，尽管情感虐待的结果总体上保持不变。
