Pain Intensity Plays a Strong Role in Increased Suicide Risk in Migraine and Non-Migraine Headache

Several studies have documented increased risk of attempted suicide in young adult migraine sufferers. A small cross-sectional study published in 1991 found that the lifetime occurrence of suicide attempts was increased in young adults with migraine, as defined by 1988 International Classification of Headache Disorders-1 (ICHD-1) criteria, even when adjusting for comorbid major depression.[1] Findings from subsequent large population-based studies have supported the association between migraine and suicide attempt, even after controlling for psychiatric comorbidity.[2,3] None of these studies, however, has tested the specificity of this association, whether suicide is linked specifically to the pathobiology of migraines or to headache pain more generally.

Results from a recent study have shed light on this question and suggest that when it comes to the link between suicide and migraine, the severity of pain, regardless of whether it is associated with migraine or not, may be the most important determining factor in increased risk for attempted suicide.[4]

A research team led by Naomi Breslau of Michigan State University in East Lansing, examined the specificity of the association between migraine diagnosis and suicide attempt risk in a prospective study that compared suicide risk in cohort of migraine sufferers (n=496), individuals with non-migraine headaches (n=151), and controls without a history of migraine or severe headache (n=539) that was randomly selected from the general population.[4] Severe non-migraine headache was defined as an intense headache with a duration of >4 hours. The groups were followed for a two-year period.

After adjusting for psychiatric illness, sex, and history of suicide attempts, individuals with migraine and those with non-migraine headache with similar intensity and disability were more 4.4 and 6.2 times more likely to attempt suicide than controls (migraine, odds ratio [OR]: 4.43; 95% confidence interval [CI]: 1.93 to 10.2; non-migraine headache, OR: 6.20; 95% CI: 2.40 to 16.0; P<0.001 for both comparisons). While both migraine and headache groups were at elevated risk for suicide, there was no significant difference in the level of risk between the two groups. Severity of headache at baseline predicted risk of suicide attempt, with a change of 1 standard deviation in pain score associated with a 79% increase in risk.

Findings from the study suggest that severity of pain, regardless of whether that pain is associated with migraine or non-migraine headache, may account for increase risk for suicide attempt. Citing recent research examining the biological underpinnings of pain disorders, the authors hypothesized that changes in brain chemistry, including serotonergic and noradrenergic functions, may provide a biological explanation of the link between severe migraine and non-migraine headache pain and suicidal behavior.

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