Early childhood trauma increases migraine risk

Why haven’t I addressed this sooner?

Well, it’s because I’m a chicken.

When the studies were first published earlier this year my gut reaction was raw emotion.  As hard as I tried to keep an open mind, each headline grated on my nerves like fingernails on a chalkboard. I was not thinking like a therapist at all. My initial response was as a migraineur who had been abused by a system that called me weak, fragile, and crazy. Like many of you, I have been subjected to “it’s all in your head”, “learn to relax”, “just take a pill”, and “maybe a therapist could help you work through your issues.” I hated the idea that doctors might start assuming every migraineur who didn’t respond to medication was a victim of abuse in need of therapy. I was afraid that these findings would destroy all our hard work at breaking down stigma.

Unfortunately, mental healthcare has played a role in creating and maintaining stigma about migraine. Having been the victim of that myth more than once, I know what it’s like to have your symptoms dismissed as psychosomatic. When it comes to migraine, I’m not crazy and neither are you. I didn't want to appear as though I was supporting these outdated notions.

I also worried that by linking migraine with abuse, it would weaken the genetic inheritance theory. Coming from a large extended family in which nearly everyone has migraine, I am emotionally invested in the idea that risk for migraine is genetic. The very idea of an environmental cause for migraine sends me reeling.

I finally realized that I was engaged in all-or-nothing-thinking. Why couldn't migraine have both genetic and environmental causes?  A lot of other diseases do. I had to get past my own faulty thinking long enough to understand the study results. I knew that once I understood the results, I could explain it to you. Now I think I’m finally ready.

An overview of the facts

To view all migraineurs as victims of early childhood trauma would be a mistake.  Anyone who tries to tell you the studies support this is wrong. The number of subjects in the study who disclosed early childhood trauma made up less than 25% of all migraineurs studied.

Just because you experienced early childhood trauma doesn’t mean that is the only reason you now have migraines. It also doesn’t mean that your migraines are caused by mental illness.  What it does mean is that those early childhood experiences may have changed the way your brain works.

If one in four migraineurs has a history of early childhood trauma, it stands to reason that some pediatric migraineurs may still be experiencing trauma, abuse, or neglect. Identifying those vulnerable kids, getting them to safety, and starting the right treatments may reduce their risk for lifetime chronic migraine.

What is early childhood trauma?

Most of you are probably thinking about child abuse. Any type of physical, emotional, verbal, or sexual abuse could certainly count as early childhood trauma. Neglect in all its forms applies as well. Several studies on the impact of early childhood trauma were conducted using subjects from orphanages where they were subjected to hours of isolation and lack of human contact. Their physical needs were met, but not their emotional needs and they still showed changes in their brain structure.

It also includes experiences most of us wouldn’t consider abuse at all. Imagine the impact of any of these on a young child: house fire, flood, earthquake, tsunami, war, famine, tornado, hurricane, and so much more. Young children who lived through Hurricane Katrina in New Orleans are perfect examples of early childhood trauma that is not abuse. Almost any disaster or traumatic event you can think of will have a greater impact on the developing brain of a young child. Even serious childhood illness can be traumatic. To ignore non-abuse trauma is a mistake.

The effects of trauma are cumulative. A young child who experiences a single traumatic event (i.e. a house fire) will be less affected than one who is exposed to a chronic cycle of neglect, abuse, and tragedy.

Why does it matter?

Children younger than 5 years lack the developmental ability to process emotions or cope with traumatic events. The child’s brain is able to sense threatening stimuli but not able to modulate the severity of the threat. Small children watch the response of their primary caregivers to determine the risk. In the absence of healthy caregiving, a child is unable to develop healthy responses to stress.

From age 15 months to 5 years certain structures of the brain that are responsible for the “fight or flight” instinct are most vulnerable to permanent damage. They develop smaller in size, more reactive to stress, and less resilient.  Other brain structures are vulnerable at different times during child development, but none have the same far-reaching impact as damage done in the first five years.

All forms of trauma affect all ages. It’s just that early childhood trauma has the potential to alter brain structure and function in such as way as to make the child vulnerable to both psychological and physiological disorders for a lifetime. Trauma can alter a person’s DNA to make them more vulnerable to certain physiological disorders later in life. We now know that migraine is one of those diseases.

How trauma affects the brain

Early childhood trauma produces long-term changes in the way the “fight or flight” response works. Essentially, trauma causes this instinct to kick in more frequently even when the person isn’t in mortal danger. It sets a person up for a chronic state of alert and elevated stress hormones. This abnormal functioning of “fight or flight” as well as high levels of stress hormones have also been observed in patients with chronic migraine.

That’s not to say that everyone with chronic migraine was also a victim of childhood trauma. Remember, less than 25% of all migraineurs in the study reported a trauma history. What it does tell us is that for patients with a history of early childhood trauma, the risk of chronic migraine is higher. Imagine if your doctor knew at the very first appointment that your stress hormones were high and your brain’s fight or flight response was hypersensitive. What if that doctor also had therapies available to retrain the brain and repair some of that damage? That is the point of this research.

There are other effects of early childhood trauma that may also impact the risk of migraine. Chronic trauma can permanently alter your brain’s ability to process several brain chemicals implicated in the migraine process.

Early childhood trauma also increases inflammatory chemicals. These have been linked to a variety of chronic pain conditions. When tested, migraineurs show an abnormally high baseline for inflammatory chemicals and an increase of these same chemicals during an attack.

Even genetics can be altered by early childhood trauma. Certain genes make people more likely to react badly to trauma.  If a child has this particular vulnerability, then they are more likely to suffer long-term changes to their brain as a result of trauma. There are also genes that make people more resilient to trauma. Severe, chronic trauma can even alter DNA.

What can be done about it?

Obviously, working to prevent early childhood trauma is essential. It is also critical to provide tools to those who work with children to identify at-risk kids and offer early interventions to mitigate the damage from trauma. Once these children have been identified, health care providers can educate parents and the child about the long-term health risks of early childhood trauma.

With regard to migraine, doctors can begin to screen migraineurs for a history of early childhood trauma and develop treatment protocols that are tailored to meet the needs of this migraine population subset. Maybe anti-depressants are chosen as first-line treatments. Maybe these patients are offered behavioral treatments designed to offset the damage done by trauma early in treatment instead of as a last resort when medications fail. Who knows what will work unless we try?

So what if I do have a history of early childhood trauma?

The research is still new. There will be a lot of trial and error before treatment protocols will be well-established. If you have a good headache specialist, you may try starting a dialogue with your doctor about these studies and how they might impact your treatment. You can also take steps yourself to add therapies that actually retrain the brain’s stress response.

Maybe you’ve tried therapy before without any change in your migraine frequency or severity. That’s certainly possible…especially since very few therapies designed to treat trauma are also designed to repair the brain. To get the best chance of success, look for a therapist who specializes in treating chronic pain. They will often use very specific therapies that may include: CBT, Behavior Modification, DBT, EFT, or EMDR. To learn more about these treatment options, see Treating migraine with talk therapy.

What if I don’t have a trauma history?

This doesn’t change the fact that migraine is a genetic, neurological disorder. Not everyone with migraine has a trauma history. Not everyone with a trauma history will develop migraine. It merely explains how sometimes traumatic events occurring at just the right time in development can alter DNA to increase someone’s vulnerability to migraine.

It is also a good reminder to all of us that migraine is still a mystery. We are witnesses to the discovery process. Sometimes uncomfortable topics must be explored in order to get all the answers.

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