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


Headache. 2018;58(3):371-380. 

In This Article


Sociodemographics are presented in Table 1 and hospital characteristics in Supporting Information Table 2. A total of 156,172,826 hospitalizations with a mean age of 57.2 years (standard error, SE = 0.1 years) were included. The majority of hospitalizations were female (59.9%), 50 years of age or older (63.7%), and had a self-identified race of white (57.4%). A total of 11.5% of hospitalizations had non-psychotic depression, 4.9% had anxiety, and 0.54% had PTSD. The majority of hospitalizations (63.8%) had two or more comorbidities as measured by the age-adjusted Charlson Comorbidity Index; 1.4% of all hospitalizations had migraine. As compared to those without migraine, migraineurs were more likely to be less than 50 years old, female, smokers, and self-identify as white (P < .0001). Migraineurs were also more likely to have depression, anxiety, or PTSD (P < .0001) than hospitalizations without migraine. Those with migraine were more likely to have ≥2 comorbid conditions than non-migraineurs (P < .0001; Table 1).

Hospitalizations with migraine had statistically significantly increased odds of suicidal behaviors (OR: 2.69; 95%CI: 2.55–2.86; Table 2). After adjusting for confounders (including age, sex, race, median household income quartiles for patient ZIP code, hospital location, hospital region, year, and age-adjusted Charlson Comorbidity Index), migraineurs had a 2.07-fold increased odds of suicidal behaviors (95%CI: 1.96–2.19; Table 2). Compared to non-migraineurs, migraineurs less than 50 years old had a 2.01-fold increased odds of suicidal behaviors (95%CI: 1.91–2.12), and migraineurs ≥ 50 years old had a 1.66-fold increased odds of suicidal behaviors (95%CI: 1.52–1.80; Supporting Information Table 3). Among women, the association followed a similar pattern (migraineurs <50 years: OR: 2.25, 95%CI: 2.13–2.37; migraineurs ≥50 years: OR: 1.60, 95%CI: 1.48–1.72). Among men, migraineurs <50 years had a 1.20-fold increased odds of suicidal behaviors (95%CI: 1.10–1.30), and older migraineurs had a 1.68-fold increased odds of suicidal behaviors compared to non-migraineurs (95%CI: 1.43–1.98; Supporting Information Table 3).

We repeated the analyses after stratifying hospitalizations according to depression, anxiety, or PTSD, respectively (Table 2). In a stratified analysis among hospitalizations with depression, migraineurs had 20% reduced odds of suicidal behaviors after adjusting for confounders (OR: 0.80, 95%CI: 0.76–0.85). Among those without depression, migraineurs had a 2.35-fold increased odds of comorbid suicidal behaviors (95%CI: 2.20–2.51) after adjusting for sociodemographic characteristics and comorbidities. In a stratified analysis, we noted that among hospitalizations with diagnosed anxiety, migraineurs had a 1.07-fold increased odds of suicidal behaviors after adjusting for confounders (95%CI: 1.02–1.13). Among those without anxiety, migraineurs had a 2.06-fold increased odds of comorbid suicidal behaviors (95%CI: 1.94–2.20) after adjusting for confounders. Similarly, in analyses stratified by PTSD status, migraine was not associated with suicidal behaviors (OR: 1.00, 95%CI: 0.94–1.07) among hospitalizations with diagnosed PTSD. However, among hospitalizations without a diagnosis of PTSD, migraine was associated with a 1.95-fold increased odds of suicidal behaviors (95%CI: 1.84–2.08; Table 2).