Posttraumatic Stress Disorder in Migraine

Authors

  • B. Lee Peterlin DO,

    1. From the Drexel University College of Medicine, Department of Neurology, Philadelphia, PA, USA (B.L. Peterlin); University of Toledo-Health Science Campus, Department of Neurology, Toledo, OH, USA (G.E. Tietjen); Nashville Neuroscience Group, Nashville, TN, USA (J.L. Brandes); Evanston Northwestern Healthcare, Glenview, IL, USA (S.M. Rubin); Maimonides Medical Center, Division of Neurology, Brooklyn, NY, USA (E. Drexler); University of California at Berkeley, The Transportation Sustainability Research Center, (J.R. Lidicker); University of Medicine and Dentistry of New Jersey, Stratford, NJ, USA (S. Meng).
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  • Gretchen E. Tietjen MD,

    1. From the Drexel University College of Medicine, Department of Neurology, Philadelphia, PA, USA (B.L. Peterlin); University of Toledo-Health Science Campus, Department of Neurology, Toledo, OH, USA (G.E. Tietjen); Nashville Neuroscience Group, Nashville, TN, USA (J.L. Brandes); Evanston Northwestern Healthcare, Glenview, IL, USA (S.M. Rubin); Maimonides Medical Center, Division of Neurology, Brooklyn, NY, USA (E. Drexler); University of California at Berkeley, The Transportation Sustainability Research Center, (J.R. Lidicker); University of Medicine and Dentistry of New Jersey, Stratford, NJ, USA (S. Meng).
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  • Jan L. Brandes MD,

    1. From the Drexel University College of Medicine, Department of Neurology, Philadelphia, PA, USA (B.L. Peterlin); University of Toledo-Health Science Campus, Department of Neurology, Toledo, OH, USA (G.E. Tietjen); Nashville Neuroscience Group, Nashville, TN, USA (J.L. Brandes); Evanston Northwestern Healthcare, Glenview, IL, USA (S.M. Rubin); Maimonides Medical Center, Division of Neurology, Brooklyn, NY, USA (E. Drexler); University of California at Berkeley, The Transportation Sustainability Research Center, (J.R. Lidicker); University of Medicine and Dentistry of New Jersey, Stratford, NJ, USA (S. Meng).
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  • Susan M. Rubin MD,

    1. From the Drexel University College of Medicine, Department of Neurology, Philadelphia, PA, USA (B.L. Peterlin); University of Toledo-Health Science Campus, Department of Neurology, Toledo, OH, USA (G.E. Tietjen); Nashville Neuroscience Group, Nashville, TN, USA (J.L. Brandes); Evanston Northwestern Healthcare, Glenview, IL, USA (S.M. Rubin); Maimonides Medical Center, Division of Neurology, Brooklyn, NY, USA (E. Drexler); University of California at Berkeley, The Transportation Sustainability Research Center, (J.R. Lidicker); University of Medicine and Dentistry of New Jersey, Stratford, NJ, USA (S. Meng).
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  • Ellen Drexler MD,

    1. From the Drexel University College of Medicine, Department of Neurology, Philadelphia, PA, USA (B.L. Peterlin); University of Toledo-Health Science Campus, Department of Neurology, Toledo, OH, USA (G.E. Tietjen); Nashville Neuroscience Group, Nashville, TN, USA (J.L. Brandes); Evanston Northwestern Healthcare, Glenview, IL, USA (S.M. Rubin); Maimonides Medical Center, Division of Neurology, Brooklyn, NY, USA (E. Drexler); University of California at Berkeley, The Transportation Sustainability Research Center, (J.R. Lidicker); University of Medicine and Dentistry of New Jersey, Stratford, NJ, USA (S. Meng).
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  • Jeffrey R. Lidicker MSc,

    1. From the Drexel University College of Medicine, Department of Neurology, Philadelphia, PA, USA (B.L. Peterlin); University of Toledo-Health Science Campus, Department of Neurology, Toledo, OH, USA (G.E. Tietjen); Nashville Neuroscience Group, Nashville, TN, USA (J.L. Brandes); Evanston Northwestern Healthcare, Glenview, IL, USA (S.M. Rubin); Maimonides Medical Center, Division of Neurology, Brooklyn, NY, USA (E. Drexler); University of California at Berkeley, The Transportation Sustainability Research Center, (J.R. Lidicker); University of Medicine and Dentistry of New Jersey, Stratford, NJ, USA (S. Meng).
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  • Sarah Meng DO

    1. From the Drexel University College of Medicine, Department of Neurology, Philadelphia, PA, USA (B.L. Peterlin); University of Toledo-Health Science Campus, Department of Neurology, Toledo, OH, USA (G.E. Tietjen); Nashville Neuroscience Group, Nashville, TN, USA (J.L. Brandes); Evanston Northwestern Healthcare, Glenview, IL, USA (S.M. Rubin); Maimonides Medical Center, Division of Neurology, Brooklyn, NY, USA (E. Drexler); University of California at Berkeley, The Transportation Sustainability Research Center, (J.R. Lidicker); University of Medicine and Dentistry of New Jersey, Stratford, NJ, USA (S. Meng).
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  • Conflict of Interest: None

B.L. Peterlin, DO, Assistant Professor of Neurology, Director, DUCOM Headache Clinic, Drexel University College of Medicine, 245 N. 15th Street MS 423, Philadelphia, PA 19102, USA.

Abstract

Objective.— To evaluate the relative frequency of posttraumatic stress disorder (PTSD) in episodic migraine (EM) and chronic daily headache (CDH) sufferers and the impact on headache-related disability.

Background.— Approximately 8% of the population is estimated to have PTSD. Recent studies suggest a higher frequency of PTSD in headache disorders. The association of PTSD and headache-related disability has not been examined.

Methods.— A prospective study was conducted at 6 headache centers. PTSD was assessed using the life events checklist and PTSD checklist, civilian version (PCL-C). We compared data from EM to CDH, and migraine with PTSD to migraine without PTSD. The PHQ-9 was used to assess depression, and headache impact test (HIT-6) to assess disability.

Results.— Of 767 participants, 593 fulfilled criteria for EM or CDH and were used in this analysis. The mean age was 42.2 years and 92% were women. The frequency of PTSD was greater in CDH than in EM (30.3% vs 22.4%, P = .043), but not after adjusting for demographics and depression (P = .87). However, participants with major depression and PTSD were more likely to have CDH than EM (24.6% vs 15.79%, P < .002). Disability was greater in migraineurs with PTSD, even after adjustments (65.2 vs 61.7, P = .002).

Conclusion.— The frequency of PTSD in migraineurs, whether episodic or chronic, is higher than the historically reported prevalence of PTSD in the general population. In addition, in the subset of migraineurs with depression, PTSD frequency is greater in CDH sufferers than in episodic migraineurs. Finally, the presence of PTSD is independently associated with greater headache-related disability in migraineurs.

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