Migraine and the risk of post-traumatic stress disorder among a cohort of pregnant women

DOI: https://doi.org/10.1186/s10194-017-0775-5

Abstract-Summary There is limited data on the association of migraine and PTSD in women during pregnancy.

Of the 2922 pregnant women included, 33.5% fulfilled criteria for any migraine

(migraine 12.5%; probable migraine 21.0%) and 37.4% fulfilled PTSD criteria.

Even when controlling for depression, women with any migraine had almost a 2-fold increased odds of PTSD (OR: 1.97; 95% CI: 1.64–2.37) as compared to women without migraine.

Women with migraine alone (i.e. excluding probable migraine) had a 2.85-fold increased odds of PTSD (95% CI: 2.18–3.74), and women with probable migraine alone had a 1.61-fold increased odds of PTSD (95% CI: 1.30–1.99) as compared to those without migraine, even after controlling for depression.

In those women with both migraine and comorbid depression, the odds of PTSD in all migraine categories were even further increased as compared to those women without migraine.

In a cohort of pregnant women, irrespective of the presence or absence of depres-

sion, the odds of PTSD is increased in those with migraine.

Our findings suggest the importance of screening for PTSD, specifically in preg-

nant women with migraine.

Extended: Of the 2922 participants, 37.4% of the participants fulfilled criteria

for PTSD.

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These findings support the need for additional research on the association between migraine and PTSD, including in pregnant women, as well as the need for research evaluating potential treatment implications of this comorbidity.

Background Migraine during pregnancy is associated with an increased risk of depression [438, 439] and suicidal ideation [440].

Both migraine and PTSD are more prevalent in reproductive-aged women as

compared to men [213, 441].

Although increasing data supports an association between posttraumatic stress disorder (PTSD) and migraine in U.S. cohorts [441–443], no prior study has exam- ined the risk of PTSD in pregnant women.

To fill in these gaps in the literature, we examined the association between

migraine and PTSD among a cohort of pregnant women in Lima, Peru.

Methods Other sociodemographic covariates included: body mass index (BMI) based on self- reported pre-pregnancy weight and measured early pregnancy BMI (<18.5, 18.5–24.9, 25–29.9, >30 kg/m2), educational attainment (≤6, 7–12, >12 years), maternal ethnicity (Mestizos of mixed Amerindian and European descent vs. oth- ers), employment status (employed vs. not employed), marital status (married or living with partner vs. other), difficulty paying for medical care (hard vs. not very hard), difficulty paying for the very basics (hard vs. not very hard), planned preg- nancy (yes vs. no), parity (nulliparous vs. multiparous), lifetime intimate partner violence (yes vs. no), childhood abuse (no abuse, physical abuse only, sexual abuse only, both physical and sexual abuse), and gestational age in weeks at the time of interview.

We examined the following covariates as potential confounders in the analyses: age, education, BMI, Mestizo ethnicity, marital status, employment, difficult paying for the basics or for medical care, parity, planned pregnancy, gestational age, child- hood abuse, lifetime intimate partner violence, and depression.

Results After adjusting for sociodemographic confounders, women with migraine had a 3.81-fold increased odds of PTSD (95% CI: 3.00–4.82) as compared to non- migraineurs, and the association remained significant after adjusting for lifetime intimate partner violence and depression status (OR = 2.85; 95% CI: 2.18–3.74).

Participants with probable migraine had a 1.80-fold increased odds of PTSD (95% CI: 1.49–2.18) as compared to non-migraineurs after adjusting for potential confounders.

Women with migraine but no depression had a 2.76-fold increased odds of PTSD (OR = 2.76; 95% CI: 1.99–3.82) after adjusting for sociodemographic confounders compared with women who had neither condition.

Compared to the reference group, participants suffering from depression and any migraine had an approximately 2.1-fold increased odds of PTSD (OR = 2.09; 95% CI: 1.49–2.92) after adjusting for potential confounders.

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Discussion In our cross-sectional study of pregnant Peruvian women, migraine (whether any migraine [migraine and probable migraine], migraine alone, or probable migraine alone) was associated with increased odds of PTSD.

To our knowledge, this study is the first to evaluate the association between

migraine and PTSD in pregnant women.

In a general population study in 2011, Peterlin et  al. reported that those with episodic migraine had a 3- to 4- fold increased odds of PTSD as compared to those without headaches after adjusting for confounders (lifetime prevalence: OR = 3.07, 95%CI: 2.12–4.46; 12-month prevalence: OR = 4.34, 95%CI: 2.73–6.89) [444].

In a cross-sectional study in Turkey, migraine was associated with PTSD among

university students (OR = 10.16, 95%CI: 3.16–32.71, p = 0.001) [445].

Our study has several strengths, including a large sample size and a population

with a high prevalence of migraine and PTSD.

Conclusions These findings support the need for additional research on the association between migraine and PTSD, including in pregnant women, as well as the need for research evaluating potential treatment implications of this comorbidity.

Acknowledgement A machine generated summary based on the work of Friedman, Lauren E.; Aponte, Christina; Perez Hernandez, Rigoberto; Velez, Juan Carlos; Gelaye, Bizu; Sánchez, Sixto E.; Williams, Michelle A.; Peterlin, B. Lee. 2017 in The Journal of Headache and Pain.

OnabotulinumtoxinA for chronic migraine during pregnancy: a real world experience on 45 patients