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Published on: June 2, 2014
Childhood Maltreatment in the Migraine Patient
Gretchen E Tietjen1, Dawn C Buse2,3, Stuart A Collins4
1Department of Neurology, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave. MS 1195, Toledo, OH, 43615, USA. gretchen.tietjen@utoledo.edu.
Insights
Childhood maltreatment heightens migraine risk by disrupting stress systems like the HPA axis. Therapies targeting stress response and epigenetic changes may benefit maltreated migraine patients.
Area of Science:
- Neuroscience
- Psychiatry
- Endocrinology
Background:
- Childhood maltreatment is a known risk factor for developing migraine.
- Stress-related physiological systems, including the hypothalamic-pituitary-adrenal (HPA) axis, endocannabinoid system, and inflammatory pathways, are implicated in both maltreatment and migraine pathophysiology.
- Glucocorticoid exposure from chronic stress can induce structural and functional changes in the limbic system, relevant to both conditions.
Purpose of the Study:
- To explore the neurobiological mechanisms linking childhood maltreatment to migraine.
- To identify potential therapeutic targets for migraine in individuals with a history of maltreatment.
Main Methods:
- Review of existing literature on the neurobiological effects of childhood maltreatment and migraine.
- Analysis of shared pathways including HPA axis dysregulation, endocannabinoid system, monoamine neurotransmitters, oxytocin, inflammation, and epigenetic modifications.
Main Results:
- Childhood maltreatment dysregulates the HPA axis and other stress-mediating systems, contributing to migraine susceptibility.
- Structural and functional brain changes observed in maltreatment survivors align with those seen in migraine patients.
- Current migraine treatments, like valproate and topiramate, may counteract stress-induced epigenetic changes.
Conclusions:
- Understanding the shared neurobiological pathways is crucial for developing targeted migraine treatments for maltreated individuals.
- Cognitive behavioral therapy and other stress-modulating interventions may be particularly effective.
- Investigating therapies targeting the endocannabinoid, serotonergic, oxytocinergic, and inflammatory systems, as well as epigenetic mechanisms, holds promise for this patient subgroup.
Opinion Statement:
Maltreatment during childhood increases vulnerability to a host of health disorders, including migraine. Putative mechanisms linking maltreatment and migraine include stress-induced dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, as well as disruption of other stress-mediating homeostatic systems, including those involving endocannabinoids, monoamine neurotransmitters, oxytocin, and inflammation. Prolonged elevation of glucocorticoids alters the neural architecture of the limbic system, resulting in the structural as well as functional changes described in both maltreatment and in migraine. Although treatment trials for migraine have not stratified participants by abuse history, strategies, such as cognitive behavioral therapy, which alter stress responsivity, may be particularly effective in this subgroup. Some therapies involving the endocannabinoid, serotonergic, oxytonergic, and inflammatory systems are under investigation for migraine. Anti-epileptic drugs such as valproate and topiramate, which are FDA approved for migraine treatment, are also known to interfere with epigenetic changes induced by stress. Discerning the role for this mechanism in treatment of maltreated migraineurs may introduce another therapeutic avenue.
