Association Between Migraine and Suicidal Behaviors

A Nationwide Study in the USA

Lauren E. Friedman, PhD; Qiu-Yue Zhong, MD, ScM; Bizu Gelaye, PhD, MPH; Michelle A. Williams, ScD; B. Lee Peterlin, DO

Disclosures

Headache. 2018;58(3):371-380. 

In This Article

Abstract and Introduction

Abstract

Background Recent studies show migraineurs are at an increased risk of developing suicidal behaviors, even after controlling for comorbid depression. However, previous research has not examined the impact of psychiatric mood disorders on suicidal behaviors in migraineurs within a nationally representative sample.

Objective A cross-sectional study was used to investigate the association between migraine and suicidal behaviors and determine whether psychiatric comorbidities modify this association in a nationwide inpatient cohort.

Methods We analyzed the Nationwide Inpatient Sample of hospitalizations compiled from USA billing data. Migraine, suicidal behaviors, and psychiatric disorders were identified based on the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes from hospitalization discharges (2007-2012). Weighted national estimates were used to estimate odds ratios (OR) and 95% confidence intervals (CI).

Results 156,172,826 hospitalizations were included, of which 1.4% had a migraine diagnosis and 1.6% had a diagnosis of suicidal behavior. Migraineurs had a 2.07-fold increased odds of suicidal behaviors (95%CI: 1.96–2.19) compared with non-migraineurs. We repeated analyses after stratifying by depression, anxiety, or posttraumatic stress disorder (PTSD). Among hospitalizations with depression, migraine was associated with a 20% reduced odds of suicidal behaviors (95%CI: 0.76–0.85). Among hospitalizations without depression, migraine was associated with 2.35-fold increased odds of suicidal behaviors (95%CI: 2.20–2.51). In stratified analyses, we noted that among hospitalizations with anxiety, migraineurs had slightly increased odds of suicidal behaviors (OR: 1.07, 95%CI: 1.02–1.13). Among hospitalizations without anxiety, migraine was associated with a 2.06-fold increased odds of suicidal behaviors (95%CI: 1.94–2.20). Similarly, in analyses stratified by PTSD, migraine was not associated with an increased risk of suicidal behaviors (OR: 1.00, 95%CI: 0.94–1.07) among those with PTSD. However, the odds of suicidal behaviors were increased among hospitalizations without PTSD (OR: 1.95, 95%CI: 1.84–2.08).

Conclusion Chronic conditions that do not affect the current hospitalization may not have been reported. The presence of psychiatric diagnoses influences associations of suicidal behaviors with migraine in a national inpatient sample. Migraineurs with diagnosed comorbid psychiatric disorders may be receiving care that mitigates their risk for suicidal behaviors.

Introduction

Migraine affects approximately 12% of the general population.[1,2] An extensive body of literature has demonstrated that migraine is comorbid with several psychiatric disorders including depression, anxiety, and posttraumatic stress disorder (PTSD).[3–6] Further, recent data support that even after controlling for comorbid depression, migraineurs are at an increased risk of developing suicidal behaviors.[7,8] Suicidal behaviors include suicidal ideation, suicide plans, and suicidal attempts.[9] The strongest predictors of completed suicide include depression and suicidal behaviors.[10,11] Thus, examining individuals more likely to exhibit suicidal behaviors is important for identifying those at highest risk of suicide. Further, targeted interventions to prevent suicide should focus on those most likely to develop suicidal behaviors.

While two studies have examined suicide in migraineurs,[12,13] few studies have examined suicidal behaviors (eg, suicidal ideation, suicide attempts). All of these studies have been relatively small or examined the association in targeted populations, ie, pregnant women,[14] adolescents,[15–17] and young adults.[4,18] Previous cohorts have included clinic[14] and community based[4,15,16,18] samples. To our knowledge, the only previous nationally representative population based study was done in a population of adolescents.[17] None have examined the association among a nationally representative adult hospital inpatient database sample or the impact of psychiatric mood disorders on the risk of suicidal behaviors in those with migraine. Therefore, our study was designed to examine the association between migraine and suicidal behaviors and the impact of comorbid mood (depression, anxiety) and stress (PTSD) disorders on this association among a nationally representative sample of adult inpatients from 2007 to 2012 in the USA.

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