In adjusted logistic regression analysis, migraineurs reporting 3 or more categories of childhood trauma were more likely to have received diagnoses of both depression and anxiety (odds ratios [OR] = 6.91, 95% confidence interval [CI]: 3.97-12.03), or either depression or anxiety PF01367338 (OR = 3.66, 95% CI: 2.28-5.88) as compared with those without childhood abuse or neglect. Conclusion.— Reports of childhood maltreatment, especially emotional abuse and neglect, are prevalent in outpatients with migraine. There is extensive overlap of maltreatment types and a high rate of revictimization in adulthood. All types of childhood abuse and neglect are

strongly associated with remote and current depression and anxiety, and the relationship strengthens with an increasing number of maltreatment types. Childhood maltreatment is a major public health problem, even in high-income countries.1 In the United States there are nearly one million substantiated reports of physical and sexual abuse of children each year, and many GDC-0068 more unverified or unreported cases.2 The majority of reported cases involve neglect, followed by physical abuse, then sexual abuse. The interrelatedness of abuse types is high.3,4 Maltreatment rates are similar for both sexes, although sexual abuse is more common in girls.2 There

is mounting evidence that childhood maltreatment has long-term consequences. In addition to being strongly tied to revictimization in adulthood,5,6 early abuse has been demonstrated to have a powerful effect on adult health. Much of the focus has been on mental health, with particularly strong associations occurring with depression and anxiety.7,8 The prevalence of early abuse has also been associated with obesity,9 impaired physical health,10,11 and health adverse behaviors, such as cigarette smoking and substance abuse.12,13 The prevalence of child maltreatment is higher in persons with chronic pain conditions, 上海皓元医药股份有限公司 although the size of the effect is a matter of debate.14,15 A number of population16-18 and practice-based

studies8,19 have demonstrated an association of childhood abuse and headache, but there remains a paucity of data specific to migraine, using either physician diagnosis or validated diagnostic instruments with standardized criteria.20 Recent headache clinic-based studies have reported increased frequency21,22 and disability22 of headache associated with physical and sexual abuse, but the questionnaire tools were not validated, and the specific impact of childhood neglect, and emotional abuse were not considered. Emotional abuse, a more elusive and insidious form of maltreatment than physical and sexual abuse, has received little scientific and public attention, and only recently is being recognized as a distinct form of maltreatment.