Gretchen Tietjen

Headache neurologist who showed adult migraine tracks childhood adversity on a clean dose-response curve — and named what "I can't think today" usually is.

A few major findings, presented as found rather than fitted to a thesis. Tietjen et al. (Headache, 2010 three-part series and 2014 consolidated analysis) — childhood adversity, particularly emotional abuse, predicts adult migraine on a dose-response curve: more ACEs, more migraine, with emotional abuse a stronger predictor than physical abuse alone. Peterlin et al. (Headache, 2009/2011) — PTSD prevalence among migraineurs runs 14–22%, roughly 3x general-population baseline. Breslau's longitudinal cohort and Friedman et al.'s 2017 meta-analysis converge on migraine roughly doubling suicide attempt risk independent of depression, with migraine-with-aura carrying the strongest signal. The condition itself is not just pain: migraine is a multi-day neurological event with a prodrome (concentration loss, fog, irritability, word-finding trouble, food cravings) hours-to-days before pain and a postdrome of similar shape afterward; a meaningful fraction of patients experience the cognitive arc without recognizable headache (silent migraine, vestibular migraine, abdominal migraine) and are typically diagnosed instead with depression, ADHD, or burnout. Borsook, Burstein, and Maleki frame the proposed mechanism as central sensitization driven by allostatic load: chronic threat-monitoring keeps the trigeminovascular system hyperexcitable; sensory gating fails; sustained attention is the first thing the system stops paying for. The honest caveat: none of this is causal proof. Reverse causation (chronic pain shapes mood and cognition over time) and shared genetic/inflammatory substrates are still in play. The dose-response is the cleanest single piece of evidence; it does not force a single mechanism. The correlation is what the data shows. What you do with the correlation is up to you.