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10/01/2008: Post-traumatic stress disorder (PTSD) occurs as a result of exposure to extreme traumatic stressors that arouse feelings of intense fear, helplessness, and horror in exposed individuals. As a result of these stressors, the individual's response characteristically involves emotionally re-experiencing the event, numbing the affect, and avoiding stimuli that are associated with the event, as well as increased arousal.
Both migraine and PTSD are more prevalent in women than men. It has been suggested that headache sufferers may have an increased risk of PTSD as compared to the historically reported prevalence for the general population. This study was designed to compare and contrast the relative frequency of self-reported PTSD, using a validated PTSD survey, in persons with episodic migraine (EM) as compared to chronic and transformed migraine. Although the definitions of chronic migraine (CM) and transformed migraine are different, for clarity purposes they are both referred to as CM. Thus the hypothesis was that chronic migraineurs would report a greater relative frequency of PTSD than episodic migraineurs.
Consecutive headache patients, ages 18-65 years, presenting for evaluation to an outpatient headache center, were asked to complete a written survey. EM and CM were diagnosed according to the criteria defined by the second edition of the international classification of headache disorders and these patients were selected for this study.
Body Mass Index (BMI) was included because of a known association between obesity and migraine as well as obesity and depression in migraine. Questionnaires completed by patients included the life events checklist (LEC) and the PTSD checklist, civilian version (PCL-C).
The LEC is a checklist used to screen for events that meet PTSD criteria and include natural disasters, serious accidents, physical assault, combat, captivity, life-threatening illness or injury, severe human suffering, sudden, violent death, unexpected death of someone close, and other disasters. Headache characteristics were assessed.
Sixty patients with a mean age of 41.4 years completed the study and, of these, 53.3% had EM and 46.7% had CM. There were no significant differences between the 2 groups with respect to age, sex, race, marital status, mean income, or BMI. A prior medical history of depression was reported in 22 of the 60 participants and it was reported in a significantly greater number of CM participants.
There was no significant difference in the percentage of participants with EM as compared to CM participants reporting at least one significant traumatic life event in both groups. The relative frequency of self-reported PTSD was significantly greater in CM participants as compared to EM, with a relative frequency of 43% and 9%, respectively.
Migraine and PTSD are relatively common presenting problems. This pilot study suggests that PTSD occurs with greater frequency in patients with CM than EM, and thus PTSD may be a risk factor for headache chronification, pending longitudinal studies to test this hypothesis. One of the implications of this study is that there should be greater consideration for the evaluation of PTSD in CM patients, as well as for the use of cognitive/behavioral therapy in this subgroup of headache sufferers.
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