Laurie Hays, 53, has had migraine attacks for more than 30 years. When they began at age 19, she assumed genetics was the cause. “We have a family history of migraines on my mom's side,” says Hays, an EMT in Charlotte, NC. But in her thirties, she began to wonder if her headaches could also be connected to a tense childhood. “Because my father was a very angry person, I spent a lot of time walking on eggshells,” says Hays. “I never knew what would set him off. I avoided him as much as possible so as not to incur his verbal abuse. As the oldest, I felt a lot of pressure to watch out for my younger siblings and to be the ‘good child.’”
Today, Hays’ parents are divorced, and she has no contact with her father. “It wasn't an easy decision to make, and I wrestled with it, but I feel healthier for having done it,” she says.
Hays’ hunch is in line with research suggesting that adverse childhood events (ACEs)—experiencing violence, abuse, or neglect between birth and age 17—could make people more susceptible to chronic illness, including neurologic disease. A review of 28 studies published in Neurology in October 2023 found that people who experienced at least one ACE were more likely to have headaches than those with no ACEs. People who experienced four such events were more than twice as likely to get headaches as those who didn't report any. According to a study published in Headache in 2020 that examined the medical records of almost 62,000 children, the risk of headache disorders was 1.3 times as high among children with one reported ACE and 3.4 times as high among children with at least four reported ACEs compared with kids who had none.
“Adverse childhood events are associated with a large number of health conditions later in life,” says Serena Orr, MD, an attending pediatric neurologist at the Alberta Children's Hospital in Calgary. “When you feel neglected or threatened in childhood—a critical period of development—bad things seem to happen to your brain and body.”
Susan Anderson, 50, had her first migraine attack 20 years ago. Initially she attributed the headaches to a work-related neck injury, but now she realizes they may be due in part to childhood trauma. She had several sexually inappropriate interactions from the age of 6, and her father handled the situation poorly, which exacerbated her trauma. “Because of his overreaction, I learned to hide and internalize anything I went through,” says Anderson, an occupational therapist in Fort Lauderdale, FL.
Several years later, Anderson was assaulted by a neighbor and an uncle. She believed her parents knew and did nothing, she says. She struggled with addiction and depression and at one point was misdiagnosed with bipolar disorder. Then her neurologist made the connection. “I only recently told her about my traumatic childhood,” says Anderson. “But it makes sense that my migraines stem, at least in part, from that. Over the years, I struggled with so much stress that I chewed through at least five mouth guards. Living with internalized turmoil takes a toll on your body long-term.”
About two-thirds of all adults have had at least one traumatic childhood experience, and one in six have had at least four, according to the Centers for Disease Control and Prevention. But for people with neurologic conditions, these events appear to have occurred more frequently. In a study published in Neurology Clinical Practice in 2021 involving 198 neurology patients, nearly one out of four had a “high ACE score” (based on responses to a questionnaire and mental health screenings), whereas about one out of eight people in the general population does. The subjects also reported more anxiety and depression, doctor and emergency department visits, and hospitalizations.
Neurologists are unsure why childhood trauma may be linked to a subsequent neurologic condition. “We suspect it has something to do with the hypothalamic-pituitary-adrenal (HPA) axis, the body's main stress response system,” says Gretchen Tietjen, MD, distinguished professor emeritus at the University of Toledo College of Medicine and Life Sciences in Ohio. The HPA axis comprises the connections among the hypothalamus, pituitary gland, and adrenal gland that work together to produce hormones that trigger the release of cortisol in stressful situations and turn it off when levels get too high. Frequent or intense stress can cause the axis to malfunction, which may lead to increased inflammation as well as changes in brain structure and function, explains Dr. Tietjen.
“In brain scans of people who have been abused, we've seen changes in structure that may activate the HPA axis,” she says, noting that axis dysfunction also could cause gut changes that affect the mix of bacteria in the gastrointestinal tract. “This increases production and release of inflammatory cytokines that could activate the trigeminal nerve, which is involved in migraine,” says Dr. Tietjen.
Headache isn't the only neurologic disorder associated with childhood trauma. Research has linked trauma to stroke, Alzheimer's disease, multiple sclerosis, and seizures, while a 2023 study published in the Journal of Head Trauma Rehabilitation found that children with more ACEs had higher odds of head or neck injury and concussion. Children with two ACEs had 24 percent greater odds of head or neck injury and 64 percent greater odds of concussion, while children with at least four ACEs had 70 percent higher odds of head or neck injury and 140 percent greater odds of concussion. One theory is that children who've experienced trauma may engage in riskier behavior, which could increase the odds of developing an injury or concussion, says study author Altaf Saadi, MD, principal investigator of the Neurodisparities and Health Justice Lab at Massachusetts General Hospital in Boston. “The ACEs themselves may change brain development, interfering with both cognitive and emotional functioning.”
Ideally, neurologists ask about a history of trauma during patient visits, although many do not because of time constraints or concerns about how to discuss the topic appropriately. Experts say research is needed to determine if all patients should be screened and what should be done if someone has had a traumatic childhood.
It's all part of trauma-informed care, says Dr. Orr. “The focus shifts from ‘What's wrong with you?’ to ‘What happened to you?’” One of Dr. Orr's patients with epilepsy, for example, had frequently been removed from home during her childhood and placed in temporary shelters. As a result, going to an institution like a hospital for treatment was frightening. “I needed to build trust with her, to take time to listen to her and validate how she felt,” says Dr. Orr. “Otherwise, she would stop coming to appointments and getting the care she needed.”
Patients whose childhoods were traumatic should let their neurologists know, if they feel comfortable disclosing it, says Dr. Saadi. “Many people don't realize the lingering impact a past trauma can have, even years later.” Reporting trauma may not change medical treatment, but it could result in referrals to additional resources, such as counseling. And some forms of counseling may improve a patient's neurologic outcome, says Teshamae Monteith, MD, FAAN, associate professor of neurology at the University of Miami Miller School of Medicine.
For those who have experienced trauma, Dr. Tietjen recommends stress-reduction practices such as meditation, mindfulness, yoga, tai chi, and biofeedback. “Each additional stressor predisposes you to more inflammation and possibly more brain changes,” she says. “If you can control your body's reaction with deep breathing, you may decrease inflammation, ease headache pain, or at least reduce your blood pressure. As a result, you'll feel better.”
Susan Anderson has found relief from stress, as well as from anxiety and depression related to her childhood trauma, by returning to her faith. She began attending church regularly about a decade ago and says it has given her a sense of purpose and belonging and has helped her heal and move on from her past.
Laurie Hays credits a reduction in migraine episodes to the right medication, strong coping strategies like joining the support group Miles for Migraine, and parenting. “My siblings and I didn't want to pass our family dysfunction on to our children,” she says. “I may not be the perfect parent, but I've tried my best. I can't prevent my kids from inheriting a familial tendency toward migraine, but I can do everything possible to raise them in a loving, stable home.”
