Emotions Enhance Pain

Chronic Headache and Migraine - What's your childhood got to do with it?

One of the common myths about migraine is that it is more common in women because women are more emotional. This is not the case. However, we are finding that there is a subset of migraine sufferers for whom past negative experiences that contain emotional links may make pain worse.

This is particularly true in the case of repressed emotions, such as those that occur because of adverse childhood experiences. A history of adverse childhood experiences has been shown to be associated with an increased incidence of depression and anxiety as well as an increase in migraines.

The types of adverse childhood experiences that have been studied include emotional abuse, physical abuse, sexual abuse, witnessing domestic violence, exposure to household substance abuse, exposure to household mental illness, parental separation or divorce, and imprisonment of a household member. A scale of Adverse Childhood Experiences has been developed for study, and is has been found that the higher the score, the higher the prevalence of headaches. It is of note that this affected both women and men.

And it makes sense, when you think about it. A child's brain is still developing, and is more likely to be affected by things they need help making sense of, things that are scary or traumatic. Occurrences of revictimization in adulthood were high, and were associated with depression and anxiety as well as increased pain. These studies suggest that adverse childhood experiences may serve as risk factors for chronic headache, including transformed migraine. Not everyone who developed chronic headache disorders also experienced depression or anxiety; these occurred more commonly but independently of one another.

Abuse and Comorbidity

In this population, there was also an association found with comorbid disorders. Emotional abuse was found to correlate with an increased prevalence of IBS, chronic fatigue syndrome, and arthritis. Physical neglect was also associated with arthritis, and with uterine fibroids in women. Physical abuse was associated with endometriosis. In general, those who had multiple types of adverse childhood experiences were more likely to have more comorbid conditions, and more types of painful conditions.

Pain and Emotions

A very interesting study of fibromyalgia patients compared them to other pain patients in their pain response to sadness and anger. Both groups showed a decreased pain threshold and pain tolerance as a consequence of these emotions. The women with fibromyalgia were not more emotional than the other women, but they did report experiencing more pain, even though when measured formally, the levels of pain threshold and pain tolerance decrease were similar. In other words, they had a differing emotional experience to the pain. This suggests that migraine, headache, and fibromyalgia sufferers who have a history of adverse childhood experiences might benefit from cognitive behavioral therapy, which can help you reframe the meaning of emotional experiences.

References:

1. Tietjen GE, Brandes JL, Digre KB, et al. History of childhood maltreatment is associated with comorbid depression in women with migraine. Neurology. 2007;69:959-968.

2. Tietjen GE, Brandes JL, Peterlin BL, et al. Childhood maltreatment and migraine (Part III). Association with comorbid pain conditions. Headache. 2010;50:42-51.

3. Tietjen GE, Brandes JL, Peterlin BL, et al. Childhood maltreatment and migraine (Part II). Emotional abuse as a risk factor for headache chronification. Headache. 2010;50:32-41.

4. Tietjen GE, Brandes JL, Peterlin BL, et al. Childhood maltreatment and migraine (Part I). Prevalence and adult revictimization: A multicenter headache clinic survey. Headache. 2009;50:20-31.

5. Anda, R, Tietjen, GE, Schulman, E, Felitti, V, Croft, J. Adverse Childhood Experiences and Frequent Headaches in Adults. Headache. 2010;50:1473–1481.

6. van Middendorp, H, Lumley, MA, Jacobs, JWG, Bijlsma, JWJ, Geenen, R. The effects of anger and sadness on clinical pain reports and experimentally-induced pain thresholds in women with and without fibromyalgia. Arthritis Care & Research. 2010;62:1370–1376.

by Christina Peterson, M.D.