by Gretchen E. Tietjen, MD

This commentary is on the retrospective cohort study by Dr. John Ney and colleagues titled Survivors of Military Sexual Trauma Face Increased Risk of Migraine Headaches and Worse Headache Care. The authors examined medical records from over 846,000 veterans, 12% of whom are women, receiving care through the Veterans Health Administration. The data stratified by positive versus negative screen for military sexual trauma (MST). To briefly summarize results, a positive MST screen was reported by 23% of the women and less than 2% of the men.

Overall, the odds of migraine were 1.6 times higher in the cohort screening positive for MST compared to those screening negative. The odds ratios are however not reported separately by sex. Veterans with MST were more likely to have other pain conditions, including fibromyalgia, depression, PTSD, and substance abuse. In persons with migraine, those who screened positive for MST were more likely to receive abortive and preventive medications discordant with the HSAN migraine treatment guidelines than those who screened negative. They also had more urgent care and emergency room visits, as well as more visits to neurologists and physiatrists.

The main finding of this retrospective cohort study is that military sexual trauma (MST) is associated with migraine. In considering this, the question arises as to the pathophysiological underpinning this relationship. The temporal association of MST and migraine are not reported, leaving one to ponder whether the emotional stressor of MST is causally-related to migraine and its comorbidities (depression, PTSD, and fibromyalgia), a trigger for worsening in cases of antecedent migraine, or both?

it’s possible that the stressor of MST triggers migraine onset or worsening, especially in those with early life stress. In considering this study’s second main finding that MST patients were more likely to go the emergency room and receive migraine medications discordant with guidelines, i.e.“worse headache care”, it may be that they have more frequent, severe, and refractory migraine, maybe related to substance abuse or comorbidities, such as anxiety, which amplify pain.

 

 

References

1. Tietjen GE, Buse DC, Collins SA. Childhood Maltreatment in the Migraine Patient. Curr Treat Options Neurol. 2016;18(7):31. Review.
2. Bandoli G, Campbell-Sills L, Kessler RC, et al. Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: a test of the stress sensitization hypothesis. Psychol Med. 2017;47(13):2379-2392.
3. Blosnich JR, Dichter ME, Cerulli C., Batten SV, Bossarte RM. Disparities in adverse childhood experiences among individuals with a history of military service. JAMA Psychiatry. 2014;71:1041–1048.
4. Katon JG, Lehavot K, Simpson TL, Williams EC, Barnett SB, Grossbard JR, Schure MB, Gray KE, Reiber GE. Adverse Childhood Experiences, Military Service, and Adult Health. American Journal of Preventive Medicine. 2016; 49:573–582.
5. Mercado RC, Wiltsey-Stirman S, Iverson KM. Impact of Childhood Abuse on Physical and Mental Health Status and Health Care Utilization Among Female Veterans. Military Medicine. 2015;180 (10):1065.