Child abuse and migraine in adulthood: A prospective cohort study spanning 20 years

Abstract Objectives This study aims to determine the long‐term impact of child abuse on the occurrence of adult migraine, to test sex differences associated with this risk, and to examine whether psychiatric disorders are explanatory mechanisms of action. Background Child abuse and adult migraine have been linked in multiple studies; however, the evidence base is marked by cross‐sectional designs and retrospective self‐reports of abuse, which may limit conclusions regarding the association. Methods In a 20‐year longitudinal cohort study conducted in upstate New York (wave 1: 1986–2009; wave 2: 2018–2024), we examined associations between Child Protective Service (CPS) documented child abuse and self‐reported lifetime and past‐year physician‐diagnosed migraine in adulthood. We controlled for key demographic and lifestyle variables, as well as depression, anxiety, and post‐traumatic stress disorder (PTSD). We also tested sex moderation. Exploratory analyses investigated whether psychiatric disorders mediate the link between child abuse and adult migraine, and whether this mechanism varies by sex. Results The present sample ( N = 305) was 51.1% female and primarily Black (59.4%), with approximately one‐third exposed to childhood abuse (34.1%). Females were more likely than males to report past year migraine as diagnosed by a medical professional (26.3% vs. 15.5%). CPS documented child abuse was associated with adult migraine for men but not women, in models adjusted for adult age, income, race, depression, anxiety, PTSD, smoking, and self‐reported maltreatment exposure (adjusted odds ratio [aOR] males = 1.77; 95% confidence interval [CI], 1.09–2.86; aOR females = 0.68; 95% CI, 0.40–1.16). This finding held when additional covariates were included in sensitivity analyses such as adult retrospective report of child maltreatment, adult sleep quality and body mass index. Depression mediated the association between child abuse and adult migraine for males. Conclusion Child abuse increases the long‐term risk for migraine among males. Given the prevalence of child abuse and the significant public health burden of migraine, understanding how and why child abuse may elevate risk of migraine is critical to informing interventions and policies to improve health and well‐being.