Migraine Without Depression, Anxiety Is Associated With Higher Suicidal Behavior Risk

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Adult participants were chosen from the Nationwide Inpatient Sample database in the United States from 2007 to 2012.
Adult participants were chosen from the Nationwide Inpatient Sample database in the United States from 2007 to 2012.

Although patients with migraine appear to be at a higher risk for suicide than the general population, migraineurs diagnosed with depression, anxiety, or posttraumatic stress disorder do not show a suicide association, according to findings from a cross-sectional study published in Headache.

The investigators used billing data from the Nationwide Inpatient Sample of hospitalizations to determine associations among migraine, psychiatric disorders, and suicidal behaviors. In this analysis, a total of 156,172,826 hospitalizations were included. Of these hospitalizations, approximately 1.4% had a migraine diagnosis and 1.6% had a diagnosis of suicidal behavior based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9), diagnosis codes.

Compared with patients without a migraine diagnosis, those with migraine had a 2.07-fold increased odds of having suicidal behaviors (95% CI, 1.96-2.19). Conversely, migraineurs with depression had 20% reduced odds of suicidal behaviors (95% CI, 0.76-0.85) vs 2.35-fold increased odds of suicidal behaviors among nondepressed patients with migraine (95% CI, 2.20-2.51).

Anxiety with migraine was associated with subtle increased odds in suicidal behaviors (odds ratio [OR], 1.07; 95% CI, 1.02-1.13), whereas migraineurs without anxiety had a 2.06-fold increased odds of suicide ideation or attempts (95% CI, 1.94-2.20). In addition, the odds of suicidal behaviors increased among patients without posttraumatic stress disorder (OR, 1.95; 95% CI, 1.84-2.08) compared with no suicidal behavior found among migraineurs with posttraumatic stress disorder (OR, 1.00; 95% CI, 0.94-1.07).

The investigators of this analysis may have misclassified suicidal behaviors in some patients because these behaviors were based on ICD-9 codes only. Because suicidal behaviors are more likely to go unreported than other health-related behaviors, this report is limited in its ability to appropriately estimate the widespread rates of migraine and suicidal behavior associations.

According to the investigators, the lack of an association between psychiatric conditions and suicidal behavior among migraineurs is likely a result of these patients "receiving care, including medication or therapy that mitigates their risk for suicidal behaviors."

Reference

Friedman LE, Zhong QY, Gelaye B, Williams MA, Peterlin BL. Association between migraine and suicidal behaviors: A nationwide study in the USA [published online November 29, 2017]. Headache. doi: 10.1111/head.13235

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