Except for sexual abuse, all the other categories of childhood trauma were associated with chronic migraine and the strongest relationship was noted with emotional abuse. All 5 categories of CB-839 ic50 childhood trauma were associated with transformed migraine. The strongest relationships were noted in migraineurs reporting emotional abuse, followed by physical abuse. Emotional abuse was also associated with severe headache-related disability, but this

relationship was marginally significant. Of all the categories of childhood trauma, only physical abuse and emotional abuse were significantly associated with chronic and transformed migraine. The associations of physical and emotional abuse with chronic migraine and transformation were further examined by controlling for current depression and anxiety. After adjusting for all previously referred variables and current depression and anxiety, only emotional abuse was associated with chronic migraine (OR = 1.77, 95% CI: 1.19-2.62, P = .004) and with transformation

(OR = 1.89, 95% CI: 1.25-2.85, P = .0027). Emotional abuse in childhood was also find more associated with the headache onset age. Headaches started at a younger age in persons reporting childhood emotional abuse. In adjusted linear regression model, headache onset age was significantly associated with emotional abuse (F = 13.89, P = .0002). In this study there are several novel findings. Our data suggest that childhood maltreatment, in particular emotional abuse, is a risk factor for chronic migraine, including transformed migraine and continuous daily headache. The association of emotional abuse with headache frequency and transformation appears to be independent of other factors, including depression and anxiety, which

are related to both childhood abuse and chronic headache. We also found that emotional abuse was associated with severe headache-related disability, allodynia, as well as with an earlier age of migraine onset. Migraine is a recurrent disorder with episodic manifestations. There is mounting evidence learn more that migraine may be a progressive disorder, with reports suggesting that in at least 3% of migraineurs each year there is an evolution from an episodic to a chronic (>15 days/month) disorder.27 Chronic daily headache (CDH), including transformed migraine, chronic migraine, and chronic tension-type headache, is believed to affect 3-5% of the general population,27 with headache phenoptype depending, in part, on the time since headache disorder onset.28 Risk factors for the development of chronic headache include female sex, lesser amount of education, obesity, and possibly a history of smoking, caffeine use, and medication overuse.10,27 In our headache clinic population, as in other studies,5,11-16 we found these factors to be associated with childhood maltreatment.