Impact of Abuse on Migraine Symptoms and Comorbidity: Results from the American Registry for Migraine Research (ARMR) (2187)

Objective: To examine associations between a history of emotional, physical, and sexual abuse with the severity of sensory hypersensitivity symptoms in patients with migraine, and to explore the mediating effect of psychiatric comorbidities.

Background: Prior studies have established an association between abuse and development of migraine and suggested this is attenuated after controlling for depression. Few studies have investigated abuse and individual migraine symptoms.

Design/Methods: 1,020 adult patients with migraine from the American Registry for Migraine Research completed questionnaires: Generalized Anxiety Disorder-7, Patient Health Questionnaire-2 for depression, Photosensitivity Assessment Questionnaire, Hyperacusis Questionnaire, and Allodynia Symptom Checklist. Patients self-reported abuse history. T-tests compared questionnaire scores between groups with and without a history of abuse. Linear regression models adjusted for demographics and headache frequency analyzed the association between abuse and sensory hypersensitivity symptoms. Adjusted mediation models analyzed the indirect mediated effect (IE) of abuse on sensory hypersensitivity through depression or anxiety.

Results: 36% of participants reported a history of abuse (n=365). Abuse was associated with greater headache frequency (p=0.019), anxiety (p<0.001), depression (p<0.001), photophobia (p<0.001), hyperacusis (p<0.001), ictal allodynia (p<0.001), and interictal allodynia (p=0.001). After controlling for age, gender, and headache frequency, abuse was significantly associated with photophobia (B=0.111, p<0.001), hyperacusis (B=4.328, p<0.001), ictal allodynia (B=0.125, p<0.001), and interictal allodynia (B=0.109, p=0.002). Anxiety significantly mediated the relationships between abuse with photophobia (IE=0.027, 95% CI=0.015–0.041), hyperacusis (IE=1.256, 95% CI=0.828–1.752), and ictal allodynia (IE=0.015, 95% CI=0.002–0.028). Depression significantly mediated the relationship between abuse with photophobia (IE=0.026, 95% CI=0.015–0.040), hyperacusis (IE=1.057, 95% CI=0.662–1.514), and ictal allodynia (IE=0.019, 95% CI=0.007–0.032).

Conclusions: A history of abuse is associated with greater migraine-related sensory hypersensitivity symptoms. Further research on the pathophysiological mechanisms underlying the relationship between abuse, psychiatric comorbidities, and migraine symptoms is needed and could lead to interventions that reduce the negative impact of abuse on the expression and severity of migraine symptoms.

Disclosure: Meesha Trivedi has nothing to disclose. Gina Dumkrieger has received personal compensation for serving as an employee of Mayo Clinic. The institution of Gina Dumkrieger has received research support from NIH. The institution of Gina Dumkrieger has received research support from DOD. The institution of Gina Dumkrieger has received research support from AMGEN. An immediate family member of Dr. Chong has received personal compensation for serving as an employee of Mayo Clinic. The institution of Dr. Chong has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AMGEN. The institution of Dr. Chong has received research support from AMGEN. The institution of Dr. Chong has received research support from Department of Defense. The institution of Dr. Chong has received research support from NIH. The institution of Dr. Chong has received research support from Department of Defense. An immediate family member of Dr. Chong has received intellectual property interests from a discovery or technology relating to health care. Dr. Dodick has received personal compensation for serving as an employee of Mayo Clinic. Dr. Dodick has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Amgen. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Allergan/Abbvie. Dr. Dodick has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AEON. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clexio. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerecin. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biohaven. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Linpharma. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Promius. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Eli Lilly. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for eNeura. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Impel. Dr. Dodick has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Theranica. Dr. Dodick has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for WL Gore. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Zosano. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for XoC. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Upjohn. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pieris. Dr. Dodick has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Revance. Dr. Dodick has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Equinox . Dr. Dodick has received personal compensation in the range of $100,000-$499,999 for serving on a Scientific Advisory or Data Safety Monitoring board for All companies listed as consultant also apply to advisory board. . Dr. Dodick has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Epien. Dr. Dodick has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for KingDevick Technologies. Dr. Dodick has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Precon Health. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Ontologics. Dr. Dodick has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Matterhorn. Dr. Dodick has received stock or an ownership interest from Healint. Dr. Dodick has received stock or an ownership interest from Theranica. Dr. Dodick has received stock or an ownership interest from Aural Analytics . Dr. Dodick has received stock or an ownership interest from Epien. Dr. Dodick has received stock or an ownership interest from Matterhorn. Dr. Dodick has received stock or an ownership interest from Ontologics. Dr. Dodick has received stock or an ownership interest from Precon Health. Dr. Dodick has received stock or an ownership interest from King Devick Technologies. Dr. Dodick has received stock or an ownership interest from Nocira. Dr. Dodick has received stock or an ownership interest from Exsano. Dr. Dodick has received stock or an ownership interest from Palion. Dr. Dodick has received stock or an ownership interest from Second opinion/mobile health. The institution of Dr. Dodick has received research support from Department of Defense. The institution of Dr. Dodick has received research support from American Migraine Foundation. The institution of Dr. Dodick has received research support from Patient Centered Outcomes Research Institute. The institution of Dr. Dodick has received research support from Henry Jackson Foundation. Dr. Dodick has received intellectual property interests from a discovery or technology relating to health care. Dr. Dodick has received intellectual property interests from a discovery or technology relating to health care. Dr. Dodick has received publishing royalties from a publication relating to health care. Dr. Dodick has received publishing royalties from a publication relating to health care. Dr. Dodick has received publishing royalties from a publication relating to health care. Dr. Dodick has received personal compensation in the range of $5,000-$9,999 for serving as a CME symposia with CME Outfitters. Dr. Dodick has received personal compensation in the range of $10,000-$49,999 for serving as a CME symposia speaker with WebMD/Medscape. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consulting with KLJ Associates. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consulting with Curry Rockefeller Group. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consulting with DeepBench. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a CME symposia speaker with Medlogix Communications. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a CME symposia speaker with Miller Medical Communications. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a speaker at annual meeting with Southern Headache Society. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a consulting with Majallin LLC. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a Consulting/Advisory board with Satsuma. Dr. Dodick has received personal compensation in the range of $500-$4,999 for serving as a CME symposia speakers with Global Access Meetings. Dr. Dodick has a non-compensated relationship as a Chair with American Brain Foundation that is relevant to AAN interests or activities. Dr. Dodick has a non-compensated relationship as a Committee member/Course Director with American Academy of Neurology that is relevant to AAN interests or activities. Dr. Dodick has a non-compensated relationship as a Chair/Immediate Past Chair with American Migraine Foundation that is relevant to AAN interests or activities. Dr. Dodick has a non-compensated relationship as a Chair Global Patient Advocacy Coalition with International Headache Society that is relevant to AAN interests or activities. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alder. Dr. Schwedt has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Allergan. Dr. Schwedt has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biohaven. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cipla. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Click Therapeutics. Dr. Schwedt has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Eli Lilly. Dr. Schwedt has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Equinox. Dr. Schwedt has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for XoC Pharmaceuticals. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Weber & Weber. Dr. Schwedt has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Headache Society. Dr. Schwedt has received stock or an ownership interest from Aural Analytics. Dr. Schwedt has received stock or an ownership interest from Nocira. The institution of Dr. Schwedt has received research support from Amgen. Dr. Schwedt has received publishing royalties from a publication relating to health care.