EHMTI-0314. A window to the past: the association between inflated pain scores and a history of abuse in women with chronic migraine

Abstract

Objectives: To evaluate the relationship between selfreported maximum pain severity scores of >10/10 on a ten-point visual analog scale (VAS) and a history of physical, sexual, and emotional abuse in women with Chronic Migraine (CM). Background(s): A history of childhood abuse has been reported in 58% of patients with either episodic migraine (EM) or CM and has also been described as a risk factor for depression, anxiety, and transformation from EM to CM in adulthood. Although the self-reporting of maximum pain severity as >10/10 on a 10-point VAS is not uncommon among patients with chronic debilitating conditions such as CM, the significance of this observation has never been investigated. Method(s): A retrospective, IRB-approved chart review was conducted on new headache consults between 1 March 2011 and 31 December 2013 with a diagnosis of ICHD-IIIbeta-defined CM based on E/M code at the time of initial consultation. All patients were seen and evaluated by the lead author either alone or while supervising a neurology resident or headache fellow. Age, sex, maximum headache severity on a 10-point VAS, and history of physical, sexual, and emotional abuse are routinely documented on each patient and were collected for this study. Twenty patient records with missing data were excluded. There were only 9 male patients in this sample, none of whom reported a history of abuse, and only one of whom reported pain >10/10, therefore, it was decided to include only female patients in the final analysis. Result(s): A total of 80 patients were included in the analysis ranging in age from 19-72 years. No statistically significant difference in age was noted between groups with the average age being 43 years in the pain >10/10 group and 40 years in the pain 10/10 and 71.2% (n = 57) reported their pain as 10/10, 87% (n = 20) reported a history of abuse compared to only 35% (n = 20) in the group reporting maximal pain < 0.001). Adjusting for age did not alter the OR for pain and abuse (adjusted OR 12, 95% CI 3.2 to 45, p < 0.001). Conclusion(s): In this population of female CM patients, selfreported maximal pain >10/10 on a 10-pointVAS correlates with a markedly higher likelihood of abuse history compared to those reporting pain 10/10.