Migraine, Tension-Type Headache Likely After Exposure to Violence

child with head down and hand in stop sign
child with head down and hand in stop sign
Prior physical or sexual abuse of survivors increased the likelihood of migraine or tension-type headache.

Adolescents exposed to violence or terror attacks have an increased risk for daily and weekly migraine and tension-type headache (TTH) following the event, according to study findings published in Neurology.

In this study, adolescent survivors of a 2011 mass shooting that occurred on the Utøya islet in Norway were interviewed (n=358) to evaluate the association of migraine frequency and severity with terror exposure. A total of 8 matched controls from the Young-HUNT3 Study were obtained for each survivor.

Primary outcome for this study was recurrent migraine and TTH over a 3-month period prior to the interview. Investigators used a validated headache interview in accordance with the International Classification of Headache Disorders to measure the primary outcome 4 to 5 months following the terror attack.

A greater percentage of survivors reported experiencing headache more frequently than matched controls. In addition, survivors were 3 times more likely to report daily or weekly headaches than controls.

According to findings from a multivariable logistic regression analysis adjusted for multiple patient baseline characteristics, prior physical or sexual abuse for survivors was significantly associated with reporting migraine (odds ratio [OR] 6.10 [3.73-9.99], P <.001) and TTH (OR 4.67 [3.12-7.00]; P <.001). In addition, the odds of reporting migraine and TTH following exposure to the violent event was 4.27 (95% CI, 2.54-7.17; P <.001) and 3.39 (95% CI, 2.22-5.18; P <.001), respectively.

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For adolescent survivors who are exposed to terror incidents, the investigators suggest “emergency preparedness planning, surveillance, and interventions may need to address survivors’ headaches to hinder chronification and to facilitate recovery.”


Stensland SØ, Zwart JA, Wentzel-Larsen T, Dyb G. The headache of terror: A matched cohort study of adolescents from the Utøya and the HUNT Study. Neurology. 2018;90(2):e111-e118.