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Migraine-Related Sensory Hypersensitivity Symptoms Associated With History of Abuse

SAP Partner | <b>Mayo Clinic</b>

Patients with a history of abuse reported a higher average or median questionnaire scores that focused on anxiety, depression, photophobia, hyperacusis, ictal allodynia, and interictal allodynia.

Recently published data from a cross-sectional observational study demonstrated that patients with migraine who have a history of abuse are associated with greater migraine-related sensory hypersensitivity symptoms, prompting the need for future studies to evaluate ways to reduce the impact of abuse.

A history of abuse, whether emotional (n = 190), physical (n = 109), or sexual (n = 116), was reported in 222 (38%) of the 588 participants. The history of abuse led to statistically significantly greater average headache frequency (7.6 vs 4.7 days; P = .030), and among patients with a history of abuse, 25% were diagnosed with episodic migraine and 75% were diagnosed with chronic migraine (P = .071).

Lead author Meesha Trivedi, BS, clinical research trainee, Mayo Clinic, and colleagues concluded that “given survivors’ increased vulnerability to more severe chronic health symptoms, these findings emphasize the importance of screening patients for abuse when treating migraine.” All patients included were from the American Registry for Migraine Research and completed questionnaires such as Generalized Anxiety Disorder-7 (GAD), Patient Health Questionnaire-2 (PHQ-2) for depression, Photosensitivity Assessment Questionnaire, Hyperacusis Questionnaire, and Allodynia Symptom Checklist (ASC).

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Statistically significantly greater depressive symptoms (P = .009; d = 0.24 [small effect]), with an average PHQ-2 score of 1.7 (standard deviation [SD], 1.7) were reported in those with a history of abuse compared to an average score of 1.3 (SD, 1.7) in the group without a history of abuse.

Those with a history of abuse had higher photophobia scores (0.54 [SD, 0.32]) than those without a history of abuse (0.44 [SD, 0.31]; P <.001; d = 0.32 [small effect]). Trivedi and colleagues also noticed a statistically significant relationship between history of abuse and more severe photophobia symptoms (B = 0.10; standard evaluation = 0.03; P <.001; f2= 0.02–small effect), which were not moderated by headache frequency (P = .065).

A history of abuse also led to significantly greater, above average, hyperacusis scores (19.6 [SD, 10.3]) compared to those without who recorded approximately average hyperacusis scores (14.9 [SD, 8.8]; P <.001; d = 0.49 [small to medium effect]).

Higher median ictal allodynia scores were found in patients with a history of abuse (6.0, consistent with “moderate allodynia”) versus those without (3.0, consistent with “mild allodynia”; P <.001; d = 0.46 [small to medium effect]). A history of abuse was associated with more severe interictal allodynia symptoms, although frequency of headache did not moderate this relationship.

Anxiety significantly mediated the relationships between abuse and photophobia (IE = 0.03 [95% CI, 0.01-0.04]), hyperacusis (IE = 1.51 [95% CI, 0.91-2.24]) ictal allodynia (IE = 0.02 [95% CI, 0.01-0.04]), and interictal allodynia (IE = 0.02 [95% CI, 0.01-0.06]). Furthermore, depression was found to significantly mediate the relationship between abuse and photophobia (indirect effect [IE] = 0.02 [95% CI, 0.01­-0.03]) and with hyperacusis (IE = 0.45 [95% CI, 0.11-0.88]).

"This suggests that while psychiatric comorbidities may influence the expression of migraine-associated sensory hypersensitivities, there is an independent relationship between abuse and these symptoms,” Trivedi et al wrote.

Trivedi M, Dumkrieger G, Chong CD, Dodick DW, Schwedt TJ. Impact of abuse on migraine-related sensory hypersensitivity symptoms: results from the American Registry for Migraine Research. J Headache Pain. Published online March 29, 2021. doi: 10.1111/head.14100