Migraine and suicide

Association Between Migraine Comorbidity and Psychiatric Symptoms Among People With Newly Diagnosed Focal Epilepsy

OBJECTIVE

Little is known about psychiatric symptoms among patients with migraine and newly diagnosed focal epilepsy. The investigators compared symptoms of depression, anxiety, and suicidality among people with newly diagnosed focal epilepsy with migraine versus without migraine.

METHODS

The Human Epilepsy Project is a prospective multicenter study of patients with newly diagnosed focal epilepsy. Depression (measured with the Center for Epidemiologic Studies Depression Scale), anxiety (measured with the 7-item Generalized Anxiety Disorder scale), and suicidality scores (measured with the Columbia-Suicide Severity Rating Scale [C-SSRS]) were compared between participants with versus without migraine. Data analysis was performed with the Kolmogorov-Smirnov test for normality assessment, the Mann-Whitney U test, chi-square test, and linear regression.

RESULTS

Of 349 patients with new-onset focal epilepsy, 74 (21.2%) had migraine. There were no differences between the patients without migraine versus those with migraine in terms of age, race, and level of education. There were more women in the group with migraine than in the group without migraine (75.7% vs. 55.6%, p=0.0018). The patients with epilepsy and comorbid migraine had more depressive symptoms than the patients with epilepsy without migraine (35.2% vs. 22.7%, p=0.031). Patients with epilepsy with comorbid migraine had more anxiety symptoms than patients with epilepsy without migraine, but this relation was mediated by age in logistic regression, with younger age being associated with anxiety. Comorbid migraine was not associated with C-SSRS ideation or behavior.

CONCLUSIONS

Among a sample of patients with newly diagnosed focal epilepsy, 21.2% had migraine. Migraine comorbidity was associated with higher incidence of depressive symptoms. Future studies should be performed to better assess these relationships and possible treatment implications.

Migraine and Suicidal Behaviors: A Systematic Literature Review

OBJECTIVE

The aim of this systematic review was to provide a picture of suicidality (suicide ideation and behavior, both fatal and nonfatal) among indviduals with migraine.

BACKGROUND

Migraine is a leading cause of disability around the world. Migraine may manifest with a number of symptoms, ranging from severe headaches to neurological sensory disturbances. Comorbid psychological conditions, such as depression, have also been linked to chronic migraine.

DATA SOURCES

Articles were retrieved from SCOPUS, PubMed, Proquest, and Web of Science.

SEARCH TERMS

Suicid* AND migrain* in English-language peer-reviewed journals between January 1, 1966 and December 31, 2014.

ELIGIBILITY CRITERIA

Original research papers providing empirical evidence about the potential link between migraine and suicidal behaviors.

RESULTS

Initial search identified 510 papers; the titles and abstracts of 360 unique results were examined for their relevance to the combination of migraine and suicidality. In total, 17 papers reporting original empirical analyses were included in this review.

CONCLUSIONS

Research has empirically documented a link between migraine and suicide ideation and behavior, particularly concerning the subtype of migraine with aura. Overall, nonfatal suicidal behavior among people with migraine has primarily been investigated, with only 2 studies analyzing suicide mortality. In addition, majority of studies originated from the United States or Canada (n=10). Future research should thoroughly define migraine and investigate link between migraine and suicide mortality.

Diagnosis and Management of Childhood Headache

Headache is one of the most common chief complaints seen in the pediatrician's office. Oftentimes, identifying the etiology of headache and differentiating primary and secondary causes can present a diagnostic conundrum. Understanding the most common causes of primary and secondary headache is vital to making a correct diagnosis. Here we review the typical presentations of the most common primary headache disorders and the approach to evaluation of the pediatric patient presenting with headache. Diagnostic workup, including the key features to elicit on physical examination, when to order head imaging, and the use of other ancillary tests, is discussed. Current treatment modalities and their indications are reviewed. We will also describe some of the new, emerging therapies that may alter the way we manage headache in the pediatric population. Headache can, at times, be a frustrating symptom seen in the pediatrician's office, but here we hope to better elucidate the approach to evaluation, management, and treatment as well as provide some hope in regards to more effective upcoming therapies.

Suicide risk in patients with migraine and comorbid fibromyalgia

OBJECTIVES

To identify the frequency, clinical effects, and suicide risk in comorbid fibromyalgia(FM) among patients with migraine.

METHODS

We surveyed patients with migraine who attended a headache clinic. All patients completed questionnaires containing demographics, headache profiles based on the International Classification of Headache Disorders, 2nd edition, FM questionnaires based on the modified 2010 American College of Rheumatology preliminary diagnostic criteria, Migraine Disability Assessment, Hospital Anxiety and Depression Scale, and Pittsburgh Sleep Quality Index. Suicide risk was evaluated by self-report of lifetime suicidal ideation and attempts.

RESULTS

Of the 1,318 recruited patients with migraine (aged 42.6 ± 12.7 years; female/male = 4.5), 10.1% (aged 44.3 ± 12.6 years; female/male = 7.9) had comorbidity of FM. Patients with migraine and comorbid FM had higher headache frequency and headache-related disability, poor sleep quality, and were more depressed/anxious than those with migraine only (p < 0.001). Suicidal ideation and attempts were reported in 27.3% and 6.9% of patients with migraine, respectively, and were higher in patients with comorbid FM than in those without (ideation: 58.3% vs 24%; attempt: 17.6% vs 5.7%; p < 0.001). In addition, comorbidity of FM was associated with a higher suicide risk in 3 different migraine subgroups, i.e., migraine without aura, migraine with aura, and chronic migraine. After controlling for covariates, comorbidity of FM remained as a predictor of suicidal ideation and attempts (odds ratio 2.61 and 1.99, respectively, p < 0.05)in patients with migraine.

CONCLUSIONS

Comorbidity with FM is associated with a high suicide risk in patients with migraine.

Taking the headache out of migraine

Migraine is a disease that contributes to major disability. Perhaps because migraine attacks are not immediately life-threatening per se and individuals return to a "normal" state between attacks, it is not taken seriously. However, migraine is associated with a number of comorbidities, including psychiatric disease, stroke, and other chronic pain disorders. Current acute treatments for episodic migraine are relatively effective, but preventive treatments for episodic and chronic migraine are far less so. Recent functional imaging studies have shown that the disease affects brain function and structure (either as a result of its genetic predisposition or as a result of repeated attacks). The current evidence in the pain field is that changes observed in brain function and structure may be reversible, adding credence to the notion that treating the disease aggressively and early may be beneficial to patients. Here we suggest a change in our approach to a disease that is currently not treated with the urgency that it deserves given its global prevalence, disease burden, and effects on brain function.

Migraine predicts physical and pain symptoms among psychiatric outpatients

Background

No study has been performed to compare the impacts of migraine and major depressive episode (MDE) on depression, anxiety and somatic symptoms, and health-related quality of life (HRQoL) among psychiatric outpatients. The aim of this study was to investigate the above issue.

Methods

This study enrolled consecutive psychiatric outpatients with mood and/or anxiety disorders who undertook a first visit to a medical center. Migraine was diagnosed according to the International Classification of Headache Disorders, 2^nd edition. Three psychometric scales and the Short-Form 36 were administered. General linear models were used to estimate the difference in scores contributed by either migraine or MDE. Multiple linear regressions were employed to compare the variance of these scores explained by migraine or MDE.

Results

Among 214 enrolled participants, 35.0% had migraine. Bipolar II disorder patients (70.0%) had the highest percentage of migraine, followed by major depressive disorder (49.1%) and only anxiety disorder (24.5%). Patients with migraine had worse depression, anxiety, and somatic symptoms and lower SF-36 scores than those without. The estimated differences in the scores of physical functioning, bodily pain, and somatic symptoms contributed by migraine were not lower than those contributed by MDE. The regression model demonstrated the variance explained by migraine was significantly greater than that explained by MDE in physical and pain symptoms.

Conclusions

Migraine was common and the impact of migraine on physical and pain symptoms was greater than MDE among psychiatric outpatients. Integration of treatment strategies for migraine into psychiatric treatment plans should be considered.

Alexithymia and its impact on quality of life in a group of Brazilian women with migraine without aura

Background

Migraine is a type of primary headache widely known for its impact on quality of life of patients. Although the psychological aspects of the disease are receiving increasing attention in current research, some of them, as alexithymia, are still seldom explored. This study aimed to provide evidence on the relationships between markers of depression, anxiety, alexithymia, self-reflection, insight and quality of life in migraine.

Methods

Forty female outpatients from a Brazilian specialized headache hospital service and a paired control group were compared.

Results

The results revealed that women with migraine had higher levels of depression, anxiety and alexithymia, and lower levels of quality of life, self-reflection and insight, compared to controls. Quality of life in women with migraine was predicted by levels of depression and one alexithymia factor (ability to express emotions and fantasies). A binary regression analysis between clinical and control groups revealed the migraine group to comprise individuals with high anxiety, low quality of life in the physical domain and the presence of a concrete thinking style.

Conclusions

The results highlight the relevance of considering psychological variables in the routine healthcare practices for migraine patients in general, while keeping steady attention to individual case features.

Cross-prevalence of migraine and bipolar disorder

OBJECTIVE

In two related studies, we explored the prevalence of migraine and its associated clinical characteristics in patients with bipolar disorder (BD) as well as psychiatric morbidity in patients treated for migraine.

METHOD

The first study included 323 subjects with BD type I (BD I) or BD type II (BD II), diagnosed using the Schedule for Affective Disorders and Schizophrenia, Lifetime version (SADS-L) format, or the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). Migraine history was assessed by means of a structured questionnaire. In a second sample of 102 migraine patients, we investigated current and lifetime psychiatric morbidity using the SADS-L. Statistical analyses were conducted using nonparametric analysis and log-linear models.

RESULTS

A total of 24.5% of BD patients had comorbid migraine; those with BD II had a higher prevalence (34.8%) compared to BD I (19.1%) (p < 0.005). BD patients with comorbid migraine had significantly higher rates of suicidal behaviour, social phobia, panic disorder, generalized anxiety disorder, and obsessive-compulsive disorder (all p < 0.05). In the sample of migraine patients, 34.3% had a current psychiatric diagnosis, and 73.5% had a lifetime psychiatric diagnosis. The prevalence of BD I was 4.9%, and 7.8% for BD II.

DISCUSSION

Migraine is prevalent within the BD population, particularly among BD II subjects. It is associated with an increased risk of suicidal behaviour and comorbid anxiety disorders. Conversely, migraine sufferers have high rates of current and lifetime psychopathology. A greater understanding of this comorbidity may contribute to our knowledge of the underlying mechanisms of BD.

Headache complaints and the risk of suicidal thoughts or behaviors

The association between severe headaches and suicidal thoughts or behaviors is generally attributed to underlying depression, but it is plausible that severe headaches can lead to suicidal thoughts/behaviors, independent of the effects of psychiatric conditions. This association has been observed in only 1 previous study. Our multivariate analysis examined the longitudinal association between severe headaches and development of suicidal thoughts/behaviors over a period of 1 to 2 years among 6832 community-dwelling adults interviewed during the Epidemiologic Catchment Area Study. Severe headaches were significantly associated with developing suicidal thoughts/behaviors after adjusting for psychiatric diagnoses and demographics [adjusted odds ratio (ORa) = 1.48; 95% confidence interval (CI) = 1.04, 2.11], or additionally adjusting for interaction between anxiety and depression (ORa = 1.52; 95% CI = 1.07, 2.16). These results suggest that individuals with severe headaches should be screened for suicidal thoughts/behaviors, irrespective of the presence of a psychiatric condition.