Migraine and Mental Health : Suicide

Migraine is such an insidious disease. We often discuss how it can rob us of time, relationships, jobs, and more. What we seldom discuss is that, in extreme cases, it can rob Migraineurs of their lives, literally. What we don't often discuss is that the risk of suicide has been found to be increased in people with Migraine.¹

When there are mental health comorbidities, which are common among Migraineurs, the statistics are startling. Pesa and Lage found that people with Migraine and mental health comorbidities were found to be three times more likely to attempt suicide than persons without Migraine.

Dr. Naomi Breslau published the results of a study that examined the risk of suicide attempts and suicidal ideation (having thoughts of suicide) in four groups:

1. people with Migraine with aura alone,
2. people with Migraine with aura and major depressive disorder,
3. people with Migraine without aura alone, and
4. people with Migraine without aura and major depressive disorder.

Breslau's findings:

• People with Migraine with aura alone had significantly higher rates of suicide attempts and suicidal ideation than people with neither Migraine nor depression.
• People with Migraine with aura and major depressive disorder (group 2) had significantly higher rates of suicide attempts and suicidal ideation than people with neither Migraine nor depression.
• Rates of suicide attempts and suicidal ideation in people with both Migraine with aura and major depressive disorder were higher than the combined rates of people with just one of the two diseases.
• People with Migraine without aura alone (group 3) was not associated with increased risk of suicide attempts and suicidal ideation.
• People with Migraine without aura and major depressive disorder (group 4) had significantly higher rates of suicide attempts and suicidal ideation than people with neither Migraine nor depression. Given that there was no increase in group 3, the researchers attributed the increase in group 4 primarily to major depressive disorder.

Breslau stated:

"These epidemiologic findings have several clinical implications. Clinicians treating migraine should be aware of the increased risk for suicidal behavior associated with migraine with aura and adapt their therapeutic approaches accordingly. Further, the significance of the comorbidity of migraine with aura and MDD (major depressive disorder), with respect to the risk for suicidal ideation and suicide attempt, should concern both medical clinicians who treat migraine and mental health clinicians who treat psychiatric disorders. The findings that a large proportion of persons with migraine with aura have a history of MDD and that the co-occurrence of migraine with aura and MDD has an interaction effect on suicidal ideation and suicide attempt emphasize the need for the coordination of medical and mental health services to assure appropriate diagnosis and effective treatment of persons with these disorders. It should be emphasized that prior suicide attempt is an important risk factor for completed suicide."³

Additional considerations:

Beginning with the Migraine prodrome and continuing through the postdrome (see Migraine Phases), levels of neurotransmitters such as serotonin, norepinephrine, and dopamine are affected. This can have a serious impact on mood and can increase suicidal ideation.

Some of the medications in use for Migraine prevention, including some antidepressants and some neuronal stabilizing agents (anticonvulsants) carry warnings that they can increase the risk of suicidal thinking and behavior.

Summary and comments:

It's essential that Migraineurs and their health care teams consider mental as well as physical health. Screening for depression and fully honest conversations are vitally important. There is nothing shameful about feeling suicidal or thinking about harming yourself, but such thoughts are a warning that you need help. If you have such feelings, discuss them with someone. Discuss them with your doctor. Get the help you need and deserve to be as healthy as possible.