Assessing the Effects of Attachment Style, Childhood Trauma on Migraine

Early life stressors such as childhood trauma and avoidant attachment style, in addition to shutdown dissociation and depression, may affect future migraine trajectory, according to results of an online cross-sectional study. Findings were published in the Journal of Trauma & Dissociation.

“Progression from episodic to chronic migraine originates from a combination of genetic, social, behavioral and environmental risk factors,” the authors explained. Although research on “risk factors for chronic migraine progression demonstrated strongest evidence for headache frequency, depression and medication overuse,” more studies are needed to better identify modifiable risk factors for migraine.

Previous investigations have also demonstrated that exposure to repeated stress could contribute to allostatic load and may cause structural and functional brain changes.

To investigate whether psychosocial risk factors predict chronic migraine or severe migraine-related disability and to examine which variables mediate these relationships, researchers recruited 507 Irish and United Kingdom participants to complete 9 self-report questionnaires.

All individuals were 18 years or older, experienced migraine, and had seen a health professional for the condition. A total of 339 patients had episodic migraine and 168 had chronic migraine, with 64, 64, 75, and 299 participants categorized as having little, mild, moderate, and severe disability, respectively, the authors wrote (5 patients were excluded from migraine-related disability analyses due to incomplete data).

Authors defined shutdown association as “neurobiological response to stress associated with a shutting down of motor sensory and speech systems and parasympathetic dominance of the autonomic nervous system (ANS).”

Adjusted analyses revealed:

• Shutdown dissociation (odds ratio [OR], 4.57; 95% CI, 2.66-7.85) and severe physical abuse (OR, 4.30; 95% CI, 1.44–12.83) had significant odds of predicting migraine chronicity.
• Mean scores for chronic migraine were significantly higher in all psychosocial variables except for Childhood Trauma Questionnaire scales sexual abuse (t[505] = −0.96; P = .339), emotional neglect (t[505] = −1.24; P = .215), and physical neglect (t[505] = −1.58; P = .115).
• Depression (OR, 3.28; 95% CI, 1.86-5.77) significantly predicted severe migraine-related disability.
• Shutdown dissociation mediated the relationship between 7 predictor variables and both chronicity and severe disability including possible predisposing factors emotional abuse, physical neglect, avoidant attachment, and anxious attachment.
• Physical abuse was the only childhood trauma to predict either outcome after controlling for confounding variables.

Overall, data showed that “psychosocial difficulties were generally more prevalent in chronic than episodic migraine and in severe than in less severe migraine-related disability,” the authors wrote. Furthermore, they found physical abuse was a superior predictor of migraine chronicity compared with emotional neglect and abuse.

More research is also warranted to investigate why shutdown association and no psychoform dissociation predicted chronic migraine.

“Incorporating biopsychosocial constructs, such as shutdown dissociation, into migraine treatment offers new strategies in reducing the risk of chronification and disability in migraine,” the investigators wrote said, adding “measuring ANS functioning through the vagus nerve, an important connection between body and brain, could offer additional insight in assessment of stress, trauma and migraine pain.”

Recall and self-selection bias could have been present during this study, marking a limitation to analyses, and under- and overreporting are also possible. The nature of the study precludes any conclusions of causality.

“An important caveat to consider with psychosocial factors in this condition is that migraineurs may also not adhere to psychological interventions, nor consider them a high priority compared to fast-acting medication,” the authors concluded.

“Furthering this area requires systematic evaluation of interventions targeting modifiable risk factors in episodic migraine over sufficient time to discern whether they can adequately reduce progression to chronic migraine status.”

Reference:

Mays I, Flynn J, McGuire B, Egan J. The role of attachment style, adverse childhood experiences and dissociation in migraine. J Trauma Dissociation. Published online October 27, 2021. doi:10.1080/15299732.2021.1989114