Suicide Attempts Due to Migraine or Pain?
Over the years, several studies have shown that people with Migraines have a higher suicide rate than those without Migraines, but those studies didn't show whether the increase is due to something about the pathophysiology of the disease or if it's because of the pain of most Migraine attacks.
In a recent study, Breslau et. al. set out to take a more definitive look at the link between Migraine and suicide.
"To estimate the risk of suicide attempt in persons with migraine vs controls with no history of severe headache, using prospective data and validated diagnostic assessment. To examine the specificity of the migraine-suicide attempt risk by comparing it to the risk associated with non-migraine headache of comparable severity and disability."1
Three diagnostic groups were randomly selected:
- people with Migraine (496),
- people with severe, non-Migraine headaches (151), and
- controls with no history of severe headache (539).
- International Headache Society International Classification of Headache Disorders, 2nd Edition (ICHD-II) criteria were used.
- Of the 4,765 people screened, 1,696 were selected for face-face psychiatric assessment. Major depressive disorder and anxiety disorders were identified using the World Health Organization Composite International Diagnostic Interview (WHO CIDI) version 2.1.
- One question from the WHO CIDI, "Did you attempt suicide," was asked of all respondents at baseline and again at the two-year follow-up.
- There were 1,186 respondents with complete data from both the baseline and follow-up assessments.
Percentages of participants with suicide attempts at the beginning of the study:
- 9.1% in the Migraine group,
- 5.3 in the headache group, and
- 2.6 in the control group.
- There were 65 suicide attempts; 52 one-time incidents and 13 recurrent cases.
The two-year cumulative occurrence of suicide attempts was:
- 8.7% in the Migraine group,
- 9.9% in the headache group, and
- 1.3% in the control group.
- Participants in the control group had a lower percentage of both major depressive disorder and anxiety disorders than both the Migraine group and the headache group.
- Researchers also estimated the risk of suicide attempts during the two-year follow-up period associated with pain intensity measured on a scale of 0 to 10. They found that the mean pain intensity score of participants who attempted suicide during the follow-up period was significantly higher than those who did not attempt suicide.
The authors concluded:
"The results suggest the possibility that pain severity might account in part for the increased risk of suicide attempt associated with migraine."1
Summary and comments:
At first look, this study seems to offer significant insight into whether the increased rate of suicide attempts is related to the pathophysiology of Migraine or the intensity of the pain. Certainly, a two-year period with over 1,000 study participants seems to be a solid study. However, one must wonder if the results would be replicated in another study where the Migraine group and the headache group were similar in size. In this study, the headache group was less than one-third the size of the Migraine group. While a study of nearly 500 (the Migraine group) people is fairly reliable, I wonder about a study of merely 150 people (the headache group).
- Three diagnostic groups were randomly selected:
Regardless, the study does verify that neither Migraine nor other headache disorders are "just headaches" to be dismissed lightly with advice such as "Take a couple of Tylenol, and get over it."
1 Breslau, Naomi, PhD; Schultz, Lonni, PhD; Lipton, Richard, MD; Peterson, Edward, PhD; Welch, K.M.A., MB, ChB, FRCP. "Migraine Headaches and Suicide Attempt." Headache. Early View. First Published online March 9, 2012. doi: 10.1111/j.1526-4610.2012.02117.x
2 Norton, Amy. "Severe headaches tied to suicide attempts: study." Reuters. March 22, 2012.
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