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31 December, 2011

One of the things that struck me in interviewing women in general was that having migraine headaches was a major red light regarding a highly possible history of childhood sexual abuse.  I saw almost no women with migraines who were not survivors. Curiously, this appeared to be a red light in men as well though men are less plagued by those headaches.

Affirmative answers regarding migraine headaches during the history-taking phase of an interview was always followed up by mental status examination questioning for the other symptoms described in posts in this blog.  I was struck by the percentage of migraine sufferers who had other PTSD symptoms associated with child abuse as well.  If ever there was a solid case for massive rage being converted into a psychophysiological symptom, this is it.

In one group session a woman spoke of having a terrible headache.  She had been to emergency rooms twice over the previous few days and had received injections of powerful pain killers to no avail.  She had been in the group for nearly a year and had made good progress.  The one thing she had avoided was her rage at her father.  In this session, which she had nearly skipped, she finally “went there” and exploded.  She raged, she knocked over a chair, she pulled at her hair and kicked a Kleenex box across the room.  When she had finished, she sat down and a curious smile spread across her face. The migraine that nothing in medicine could touch had vanished in the course of a few minutes.

Due to their “medical model” approach to the problem, physicians and researchers have focused on any number of physical causes of these headaches, and any number of treatments for them.  When confronted with a patient who has migraines, they would do well to delve a bit into their childhood histories.  I recall doing a lunch in-service presentation at a teaching hospital 25+ years ago about this and the reception of the idea that migraines were linked to abuse was at best lukewarm — and sometimes hostile.  One doctor fairly sneered at the idea.  I asked him why he was so resistant to the idea, and suggested he let it prove its self to him.

Fortunately, the link was eventually noticed by physicians in ensuing decades (and their observations are what matter, of course).  Google “migraines sexual abuse” and now you’ll find a multitude of references confirming the link between the history of abuse and that symptom.

As a footnote, the University of Minnesota, in an inspired research study, found that sexual abuse survivors were significantly more likely to suffer a wide variety of physical and medical problems.  I can’t express how gratified I was to have my own, anecdotal observations of that confirmed by that research as well.

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    • Thank you, Eunice. I’ve added Depending On You to my links. Prevention, and early reporting to both minimize damage and get early help is so very important.

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