Pregnant Women With Migraine More Likely to Have PTSD

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Of the participants, 37.4% met the criteria for PTSD.
Of the participants, 37.4% met the criteria for PTSD.

Women who are pregnant and have migraine are more likely to have posttraumatic stress disorder (PTSD) than women without migraine, regardless of the presence of diagnosis of depression, according to study results published in The Journal of Headache and Pain.1

Previous research has demonstrated a greater prevalence of PTSD and migraine in women of reproductive age,2,3 but no study has focused on the association between PTSD and migraine in pregnant women. In order to determine whether such an association exists, Lauren Friedman, PhD, of the Harvard TH Chan School of Public Health in Boston, Massachusetts, and colleagues conducted a cross-sectional study in women attending prenatal clinics in Lima, Peru.

Participants in this study were drawn from the Pregnancy Outcomes, Maternal and Infant Study (PrOMIS) cohort. Data were collected from February 2012 to March 2014. Overall, 2922 women (age 18 to 35) were included in the analysis. The International Classification of Headache Disorders (ICHD)-III beta criteria were used to classify migraine and probable migraine. The PTSD Checklist-Civilian Version (PCL-C) is a self-report measure used to asses PTSD. 

In the 2922 participants, average gestational age at interview time was 9.23 weeks. The majority of participants were married or living with a partner, and had less than 12 years of education. The overall prevalence of any migraine (migraine or probable migraine) was 33.5%; women with migraine were more likely to be unemployed, have financial difficulties, be of Mestizo descent, and have a history of child or domestic abuse. Of the participants, 37.4% met the criteria for PTSD; those participants were more likely to have financial difficulties, a history of domestic abuse, and depression.

Overall, a history of any migraine was significantly associated with higher odds of PTSD (odds ratio [OR] 2.50; 95% CI 2.14-2.93). After adjusting for sociodemographic factors, domestic abuse, and depression, women with any migraine had a 1.97-fold increased odds of PTSD (95% CI, 1.64-2.37) compared with women without migraine. Women who met the criteria for migraine had 2.85-fold greater odds of PTSD (95% CI, 2.18-3.74) after accounting for confounders. Participants with probable migraine also faced increased odds of PTSD, even after adjusting for confounding factors. In women with depression, women with migraine and women with probable migraine faced 3.13-fold and 1.59-fold increased odds of PTSD, respectively, compared with women without migraine.   

While the study had a large sample size with a high prevalence of migraine and PTSD, the investigators pointed out that the study was conducted in low income pregnant women in Peru, and therefore cannot be generalized to all pregnant women. They also noted that diagnoses of migraine and PTSD were based on self-report questionnaires, which may have allowed for underreporting.

Overall, the results of this study show the need for further research on the connection between migraine and PTSD in pregnant women and the importance of screening for PTSD in this population.

References

  1. Friedman LE, Aponte C, Hernandez RP, et al.  Migraine and the risk of post-traumatic stress disorder among a cohort of pregnant womenJ Headache Pain. 2017;18(1):67.
  2. Lipton R, Bigal M, Diamond M, Freitag F, Reed M, Stewart W; for the AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 68(5):343-349. 
  3. Peterlin B, Nijjar S, Tietjen G. Post-traumatic stress disorder and migraine: epidemiology, sex differences, and potential mechanisms. Headache. 51(6):860-868. 
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