Prevalence of adverse childhood experiences in the refractory chronic migraine population compared to non-refractory chronic and episodic migraine.

OBJECTIVE

To analyze adverse childhood experiences (ACEs) scores, headache frequency, and disability (six-item Headache Impact Test [HIT-6], Migraine Disability Assessment Scale [MIDAS]) in individuals with refractory chronic migraine (rCM) recommended for inpatient infusion therapy (IIT), compared to those with non-rCM and episodic migraine (EM).

BACKGROUND

Migraine is a highly disabling condition with genetic and environmental contributors, including ACEs. Prior studies have demonstrated an association between ACEs and CM. No studies to date have focused on the specific population of individuals with rCM recommended for IIT.

METHODS

This was a cross-sectional, chart-review, single-institution study of patients with rCM recommended for IIT in 2023; the comparison non-rCM and EM groups were derived from all new patient encounters in 2023. We outlined criteria for refractoriness considering the number and class of preventives tried, with contributions from proposed definitions from the American Headache Society and European Headache Federation. The non-rCM and EM groups were derived from sorting by the International Statistical Classification of Diseases and Related Health Problems 10th Revision diagnosis. Data were collected from the New Patient Questionnaire, routinely administered to all new patients, and documentation in the electronic medical record. We examined ACE score, headache frequency, HIT-6 score, and MIDAS score for the three groups: rCM, non-rCM, and EM.

RESULTS

There were 68 patients in the rCM group, 101 in the non-rCM group, and 68 in the EM group. There was no statistically significant difference in the median ACE scores between the rCM (median [interquartile range, IQR] 2 [0-5]) and non-rCM (median [IQR] 1 [0-3]) groups (p = 0.230), but the comparison between the rCM and EM (median [IQR] 0 [0-2]) groups was significant (p = 0.013). The median headache frequency (reported in monthly headache days) was significantly higher in the rCM group (median [IQR] 30 [30-30]) compared to the non-rCM (median [IQR] 25 [18-30]) (p < 0.001) and EM (median [IQR] 8 [4-10], p < 0.001) groups. Finally, the rCM group had significantly higher median MIDAS (median [IQR] score 108 [49-161] vs. 36 [21-105], p < 0.001) and HIT-6 (median [IQR] score 67 [64-70] vs. 65 [62-68], p = 0.008) scores compared to those of the non-rCM group. All outcomes (ACE score, frequency, disability) were significantly higher for the rCM group versus the EM group.

CONCLUSION

In this first study to characterize ACE scores in those with rCM recommended for IIT, we found that the ACE score, headache frequency, MIDAS score, and HIT-6 score were significantly higher in the rCM group versus the EM group. Headache frequency, MIDAS score, and HIT-6 score were significantly higher in the rCM group versus the non-rCM group, but no significant difference was found for ACE scores between these two CM groups. Our results agree with prior research demonstrating an association of ACEs with migraine and its chronification. Further study is required to better understand how ACEs influence migraine and its refractoriness to treatment.