EHMTI-0314. A window to the past: the association between inflated pain scores and a history of abuse in women with chronic migraine

Introduction

Childhood abuse is a risk factor for depression and anxiety and is reported by 58% of patients with episodic migraine (EM) or chronic migraine (CM). Maximum headache severity >10/10 on a 10-point visual analog scale (VAS) is not uncommon among CM patients. The relationship between inflated pain scores and abuse has never been investigated.

Aims

To evaluate the relationship between pain severity >10/10 on a ten-point VAS and a history of abuse in women with CM.

Methods

A retrospective review was conducted on new headache consults in female patients with ICHD-IIIβ-defined CM over a 34-month period. Age, maximum headache severity on a 10-point VAS, and history of physical, sexual, and emotional abuse were collected.

Results

80 patients were included. Average age was 43 years in the pain >10 group and 40 years in the pain ≤10/10 group (range 19-72 years; 95% CI -3 to 10, p=0.31). 28.8% (n=23) reported maximal pain >10/10 and 71.2% (n=57) reported maximum pain ≤10/10. Of those reporting pain >10/10, 87% (n=20) reported an abuse history compared to 35% (n=20) in the pain ≤10/10 group (OR 12, 95% CI 0.33 to 0.70, p<0.001).

Conclusions

Among female CM patients, pain >10/10 correlates with a markedly higher likelihood of abuse compared to those reporting pain ≤10/10. As history of abuse is a risk factor for depression and anxiety, and treatment of psychopathology can influence CM treatment outcomes, all CM patients should be screened for a history of abuse, with special attention to those reporting pain >10/10.

No conflict of interest.