Follow-Up On Childhood Abuse and Migraine Report
In response to the blog about the link between childhood abuse and neglect with adult migraine, Ellen asked, "Dr Marcus, Do you have any thoughts about how revealing this type of abuse to doctors might change how they choose to treat a patient?" I immediately thought that, if I were Ellen's doctor, I would be to talk to our team psychologist about the abuse. This doesn't mean Ellen and I wouldn't ALSO get started with typically helpful migraine therapy, but it does mean that the effect of abuse also needs to also be treated by a specialist. In many ways, this would be the same as if I identified another problem during the visit. If Ellen also had uncontrolled blood pressure, I'd talk to her primary care doctor about getting the high blood pressure under control at the same time that she and I were working on her migraines. Patients shouldn't be afraid that their doctor won't treat their migraines because they also have other problems.
So I asked one of my favorite experts how a good psychologist would use this information. My expert is Dr. Dawn Buse, a psychologist and assistant professor at Albert Einstein College of Medicine. She works with renown headache specialist Richard Lipton. One of their best-known projects is the American Migraine Prevalence and Prevention project, that involves a large population survey about migraine frequency, disability, and healthcare utilization.
Here's what I learned from Dr. Buse:
- In addition to an increased risk for migraines, having been the victim of abuse can result in other problems that can persist into or develop during adulthood:
- Engaging in behaviors that harm others (continuing the cycle of abuse) or harm yourself (including things like cutting or burning yourself or suicide attempts)
- Post-Traumatic Stress Disorder (PTSD), with flashback or nightmares, anxiety, avoidance of reminders of the abuse, and having difficultly connecting closely with others
- One of the best treatments for the effects of abuse, neglect, and PTSD is cognitive-behavioral therapy, where you work on identifying distressing and dysfunctional patterns of thinking and change them to less destructive ones. Changing your thoughts are often an important first step toward improving behaviors and symptoms. Relaxation techniques and mindfulness meditation can also be helpful.
So the bottom line is this -- your childhood abuse and neglect may be negatively affecting you and those around you. Hiding signs of abuse doesn't make the consequences of abuse go away. The consequences of abuse need to be treated seriously, just like your other health problems. It's important to make sure you work with a professional who can help you identify how the abuse may be affecting you today and to teach you ways take back control of your life.
To see if you might have PTSD, visit the National Center for PTSD website and complete their 4-question Primary Care PTSD Screen. If you answer 3 of the 4 questions "yes," you need to talk to your doctor about PTSD
To get more information and find a licensed psychologist near you, visit out these websites:
Can you tell when a migraine attack is coming?