Review Explores Association Between Chronic Migraine, Suicide Ideation

Current existing research highlights the important association between the increased risk of suicidal behaviors among chronic migraineurs with and without aura, in both the clinical and general population worldwide, according to a systematic review published in Frontiers in Neurology.

The prevalence of migraine ranges between 11% and 23% while the condition accounts for 5.6% of disabilities worldwide. However, despite “affecting 1 in 7 people worldwide, migraine continues to be underrecognized, underdiagnosed, and undertreated,” researchers write.

The condition is classified as a recurrent headache disorder lasting between 4 and 72 hours, predominately associated with autonomic nervous system symptoms. In addition, clinical anxiety and depression are typically more common among migraineurs.

Frequent migraine episodes are considered chronic “when they occur for a period of at least 3 months, on more than 15 days per month, and the headaches have migraine characteristics on more than half of the episodes.”

In the current review, researchers compiled studies published between January 2015 and November 2019 on Medline, sycINFO, EMBASE (Ovid), Science Direct (Elsevier), Cochrane, and PubMed. All studies included participants aged 16 and over who had been diagnosed with migraine. The studies also included the following outcome variables: any suicidality, both fatal and non-fatal; suicidal ideation; and suicidal behavior.

After screening and full-text review, a total of 10 studies were eligible for inclusion. Two studies were conducted in Canada, 2 in Taiwan, 2 in Korea, and 1 each in Ethiopia, France, Peru, and the United States. All studies were published in the English language while 7 used a cross-sectional design and 3 were prospective cohort studies.

Participants were recruited from both outpatient clinics (including those for epilepsy, stroke, and gynecology) and nationwide samples (via hospital billing data, community-based mental health survey data, and a national health database). All studies also included a control group.

Twenty percent of the studies included were considered high quality, as they were associated with less risk of bias, while 60% were assessed as moderate quality, and 20% were between moderate and low quality.

The review found:

• All of the studies included other comorbidities mainly associated with mental health (anxiety, depression, major depressive disorder, or substance abuse or dependence on alcohol, drugs, and other substances)
• Women who were experiencing both migraine and depression showed an almost 4 times higher rate of suicidal ideation compared with those who didn't have either of those disorders
• Suicide attempts were higher in participants with depression, anxiety, insomnia, and alcohol-related illnesses
• The trend of a strong correlation between migraine and suicidal ideation observed after adjusting for confounders was reflected in 5 of the articles reviewed
• Migraine with aura exhibited a stronger relationship with suicidal behavior than migraine without aura, and this remained evident after controlling for age, gender, and psychiatric conditions; suggesting an independent association between migraine with aura and suicidal behaviors
• 6 studies discussed the connection between biological mechanisms, migraine, psychiatric disorders, and suicidal behaviors, although evidence is limited

Based on these findings, authors propose therapeutic migraine strategies should include screening for anxiety, suicidal behavior or ideation, and other psychiatric disorders. “The treatment strategies targeting both migraine and comorbid disorders will have a better outcome for the migraine sufferers and could prevent more serious actions such as suicide,” they write.

“Collectively, all the studies suggest an association between migraine, suicidal behaviors, and comorbidities, including psychiatric disorders, and demonstrate an increased risk of suicidal behaviors in both clinical and general population migraineurs,” authors conclude.

Promoting better care for migraineurs can act as the first step in preventing suicidal behavior among patients with migraine, researchers argue.

“Future studies are needed to facilitate the development of clinical guidelines for risk assessment, targeted interventions, and evidence-based treatment of migraine to minimize the risk of suicide among this vulnerable population.”

Reference

Karimi L, Hoppe D, Burdick C, et al. Recent evidence regarding the association between migraine and suicidal behaviors: a systematic review. Front Neurol. Published online June 23, 2020. doi:10.3389/fneur.2020.00490