Emotional abuse in children can cause migraines later on as young adults — even more so than physical or sexual abuse, according to a new study out of the University of Toledo. In the past, researchers linked any type of child abuse to an increased risk of migraines later on, but this is the first study to find that emotional abuse may be the worst culprit of all.

The study, which will be presented at the American Academy of Neurology’s 68th Annual Meeting in Canada in April, examined data from 14,484 people aged 24 to 32. The researchers asked participants to report on physical abuse (being hit, kicked, thrown down) and sexual abuse (forced sexual touching) that occurred to them during childhood. They rated emotional abuse by asking participants, “how often did a parent or other adult caregiver say things that really hurt your feelings or made you feel like you were not wanted or loved?”

14 percent of the participants were diagnosed with migraines, and out of that number, 61 percent said they had been abused as a child, compared to 49 percent of those who hadn’t been abused. The researchers calculated that children who had been abused were more than twice as likely (55 percent) to experience migraines later on. Interestingly, however, it was specifically emotional abuse that showed the greatest link to migraines.

Participants who had been emotionally abused were 52 percent more likely to experience migraines than those who hadn’t been abused; sexual or physical abuse cases, however, didn’t come with a much higher likelihood to lead to migraines in comparison to people who weren’t abused.

“Emotional abuse showed the strongest link to increased risk of migraine,” Dr. Gretchen Tietjen of the University of Toledo, an author of the study, said in the press release. “Childhood abuse can have long-lasting effects on health and well-being.”

Aside from the direct mental health consequences of abuse, such as depression or post-traumatic stress disorder (PTSD), it can have detrimental physical effects too — like an increased risk of infertility in females later on, according to a 2015 study. And while physical and sexual abuse may seem far worse than emotional abuse, some researchers have argued that emotional abuse can be just as bad; neglect and mistreatment could be just as damaging as a slap in the face.

Tietjen notes that “more research is needed to better understand this relationship between childhood abuse and migraine,” but it still may be something for doctors to consider when treating migraines.

Source: Tietjen G, et al. American Academy of Neurology, 2016.