Migraine and Suicide

Written by: Kylie Petrarca, RN, BSN

Medically Reviewed by: Dr. Melissa Geraghty

Edited by: Leigh Serth and Elaine Alibrandi 

In 2020, there were more than 1.2 million suicide attempts, and almost 46,000 people died by suicide in the United States.¹ In addition, almost 40 million Americans live with migraine disease.² Unfortunately, people living with migraine have higher rates of suicidal ideation. Pain intensity, migraine type, age and other comorbidities play a role in the relationship between suicide and migraine.

Suicidal Thought Versus Suicidal Ideation

Suicidal thoughts may be a common occurrence but it is important to note that there is a difference between a passing thought and active suicidal ideation, which is when a person has thoughts with a plan and means.

Risk Factors for Suicide

Researchers have identified a number of risk factors that may make someone more susceptible to suicide. About 90% of people who die by suicide have an underlying mental health condition such as anxiety, depression, schizophrenia, etc. but there are often other factors involved as well.³ See other risk factors below.

Medical History

• One of the strongest risk factors for suicide is a history of an attempt
• Mental health conditions can increase risk of suicide³
• Living with a chronic pain condition such as migraine, especially migraine with aura
• History of a traumatic brain injury
• Family history of a suicide attempt. A study reported that a child of a parent who has attempted suicide is almost five times more likely to attempt suicide.⁴ 

Environmental Factors

• Childhood adverse events, such as physical and/or sexual abuse or trauma
• Domestic abuse
• Bullying/cyberbullying
• Stressful event such as divorce or loss of a loved one
• Exposure to another suicide
• Recent release from jail or prison
• Homelessness
• Foster care or adoption

Other Factors

• Men are at higher risk of suicide than women
• A close friend history of suicide or suicide attempts⁵
• Young adults between the ages of 10 – 35 have the highest suicide rates⁶

The Relationship Between Suicide and Migraine

Association of Suicide Risk With Headache Frequency Among Migraine Patients With and Without Aura – Lin et al. 

This study found that people who live with migraine experience higher levels of suicidal ideation compared to healthy controls.⁷ Of note, people who have migraine with aura were found to be 5.8 times more likely to attempt suicide compared to those without aura.⁷ Among people living with chronic migraine with aura, the study found 47.2% of people had suicidal ideation and 13.9% attempted suicide.⁷ In addition, the number or frequency of migraine attacks were correlated with people who experienced an aura rather than other types of migraine.⁷ Other factors that were also associated with suicide in people who live with migraine were a low education level and a high depression score (based on the Beck Depression Inventory scale).⁷

Depression, Suicide and Migraine 

Depression is a significant comorbidity among people living with migraine. More information about the relationship between depression and migraine can be found here. According to Dr. Dawn Buse at the AMD 2021 symposium, those with depression are 3.4 times more likely to develop migraine, and conversely those with migraine are 5.8 times more likely to develop depression. Regarding the relationship between suicide and depression, about 90% of people who die by suicide have an underlying mental health condition such as anxiety, depression, schizophrenia, etc.³ It is important to note that depressive symptoms are common during a migraine attack, and people who are at a high risk for suicide may need additional support and/or monitoring during their attacks.⁸

Migraine in Adolescents

Suicide is one of the leading causes of death among adolescents.⁹ A study that looked at suicidal ideation in adolescents with migraine aged 13-15 found that those with migraine had a higher frequency of suicidal ideation (16.1%) compared to those without migraine (6.2%).¹⁰ The adolescents who had migraine with aura showed the highest risk of suicidal ideation (23.9%).¹⁰ The study also assessed the number of headache days in relation to suicidal ideation. Those who had 7-14 headache days per month experienced the highest rate of suicidal ideation.¹⁰

Migraine, Pain Intensity and Suicide 

As previously discussed, migraine with aura, comorbid depression and the number of headache days can all contribute to suicidal ideation. But what about pain intensity? Breslau et al. assessed a group of people with migraine disease, non-migraine headache and people who never had a headache above mild severity at baseline and then again at two years.¹¹ The researchers found that the risk of suicide attempts increased by 17% with each 1-point increase in headache severity on a pain intensity scale (0-10).¹¹ They also found that baseline head pain level was higher in people who attempted suicide (7.58) versus people who did not attempt suicide (5.18).¹¹ This highlights the need for adequate migraine treatment, frequent pain assessment by a clinician and a sufficient migraine action plan.

Commonalities Between Migraine and Suicide

• History of trauma including childhood physical and/or sexual abuse is a risk factor for both migraine and suicide
• Veterans have higher suicide rates and are more likely to experience migraine and other headache disorders than non-veterans.^12,13
• LGBTQI individuals are more likely to live with migraine and also have a higher rate of suicide.¹²
• Mental health conditions are more prevalent among people who die by suicide and also in people who live with migraine disease. See the Migraine Comorbidities Library for more information on migraine and mental health conditions. 
• Both suicide and migraine are more prevalent in those with mental health conditions
• The pathophysiology between migraine and suicide likely involves dysfunction of the hypothalamic–pituitary–adrenal (HPA) axis and abnormalities in serotonin.⁷
• A variation in a dopamine gene has been associated with suicide, migraine with aura, major depression, and generalized anxiety disorder.^7,14
• Fibromyalgia is a comorbid condition to migraine and suicide. A study found that fibromyalgia was a predictor of suicidal ideation and attempts in patients with migraine. There was a higher suicide risk in people living with migraine without aura, migraine with aura and chronic migraine.¹⁵ Read about the relationship between migraine and fibromyalgia here.

Warning Signs 

In addition to risk factors, people may exhibit warning signs that can alert others of potential suicidal behavior. 

• Talking about dying or having no reason to live
• Feeling like a burden or feeling hopeless or trapped
• Selling or giving away items
• Withdrawing from family and friends
• Saying goodbye to loved ones
• Sleeping too much or too little
• Engaging in risky behavior such as excessive drinking, using drugs, etc.

For more warning signs, visit the American Foundation for Suicide Prevention.

Treatments

Treatment varies depending on the situation. If someone has attempted suicide, it is recommended to call 911 (in the USA). The person will be brought to the emergency room and evaluated by a clinician. They may also be kept under observation depending on the threat of harm to themselves or to other people. If someone has suicidal ideation, it is recommended to contact the Suicide Hotline (988). They may also be brought to the emergency room depending on the evaluation of emergency personnel. 

Treatment is often multidisciplinary and may involve therapy, intervention and/or medication. 

• Talk therapy, cognitive behavioral therapy for suicide prevention (CBT-SP) and grief therapy are commonly used
• Different types of interventions may include: safety planning and crisis response planning
• Antidepressants, antipsychotic or anti-anxiety medications such as are often used if the person has a comorbid mental health condition. Antidepressants have a black box warning, and people with suicidal ideation should be closely monitored when beginning an antidepressant

View more information about treatments here.

Ketamine is an emerging treatment for both suicidal thoughts and migraine. Ketamine was found to have benefits for the acute treatment of suicidal ideation and has also been used for the treatment of migraine.¹⁶ You can learn more about the benefits of ketamine here. Psychedelics have also been found to decrease suicidality as well as migraine frequency and pain.^17,18

What Type of Doctor Should I See for Migraine and Suicide Risk? 

Migraine is best treated by a clinician who specializes in headache medicine. A psychiatrist, pain psychologist, clinical health psychologist, rehabilitation psychologist or other mental health professional is typically involved in the assessment and evaluation of a suicidal person.

A Note To Patients and Providers

People who live with migraine, particularly migraine with aura, are at the highest risk for suicide. Other risk factors for suicide among people with migraine include: comorbid mental health conditions, increased pain intensity and frequency of migraine attacks. Clinicians should regularly screen for suicidal thoughts and/or previous suicide attempts and re-evaluate as necessary. Patients should report suicidal ideation, increased pain or previous attempts. Treatment will vary based on the individual. For more information about suicide, visit the American Foundation for Suicide Prevention.

What Happens When Someone Calls the Crisis Line? By Yuri Cárdenas

I was a San Francisco Suicide Prevention Crisis Line counselor, before chronic migraine stopped me, and I was also a Crisis Line caller. The people who answer the calls are there to support you through a time of crisis, or if you just need someone anonymous to talk to. You’ll first hear a recording with some options, and then the calls are automatically routed to counselors in your area. You can expect to be evaluated for the level of risk of suicide. It is important to note the possibility of police or other emergency responders being called if someone is in imminent danger of hurting themselves or others. That can be really detrimental, especially for people of color. If you are concerned about this risk, visit our resources section below. Remember, there is nothing to be ashamed of and the feeling will pass, even when you are sure it will go on forever.

Thank you to our sponsor Lundbeck!

Lundbeck, a global pharmaceutical company based in Denmark and founded in 1915, is tirelessly dedicated to restoring brain health, so every person can be their best. Lundbeck has a long heritage of innovation in neuroscience and is focused on delivering transformative treatments that address unmet needs in brain health.

For more information, visit: http://www.lundbeck.com/us

Resources 

1. Risk Factors and Warning Signs
2. What We’ve Learned Through Research
3. Interventions and Treatments for Suicide
4. Migraine and Suicide Blog
5. US Veterans and service members can call 988 and then press 1, or text 838255, or chat using veteranscrisisline.net/get-help-now/chat/
6. The US Suicide and Crisis Lifeline also has a Spanish-language phone line: 1-888-628-9454
7. 988 – New Nationwide Number for the Suicide Crisis Hotline

Additional Resources from NPR¹⁹

• Blackline – Peer support hotline for Black, Brown and Indigenous people
• Kiva Centers – Daily online peer support groups
• Peer Support Space – Virtual peer support groups twice a day Monday through Saturday
• Project LETS – Text support for urgent issues that involve involuntary hospitalization
• Trans Lifeline – Peer support hotline for trans and questioning individuals
• Wildflower Alliance – Has a peer support line and online support groups focused on suicide prevention

References

1. https://www.cdc.gov/mmwr/volumes/71/wr/mm7108a5.htm
2. https://headaches.org/facts-about-migraine/
3. https://afsp.org/what-we-ve-learned-through-research
4. JAMA Psychiatry. 2015 February ; 72(2): 160–168. doi:10.1001/jamapsychiatry.2014.2141.
5. Bilsen J (2018) Suicide and Youth: Risk Factors. Front. Psychiatry 9:540. doi: 10.3389/fpsyt.2018.00540
6. https://www.medicinenet.com/what_age_group_is_the_most_suicidal/article.htm
7. Lin YK, Liang CS, Lee JT, Lee MS, Chu HT, Tsai CL, Lin GY, Ho TH, Yang FC. Association of Suicide Risk With Headache Frequency Among Migraine Patients With and Without Aura. Front Neurol. 2019 Mar 19;10:228. doi: 10.3389/fneur.2019.00228. PMID: 30941087; PMCID: PMC6433743.
8. https://www.sciencedirect.com/science/article/pii/S0165032721011289
9. https://www.cdc.gov/nchs/fastats/adolescent-health.htm#:~:text=Leading%20causes%20of%20deaths%20among,Suicide
10. Migraine and suicidal ideation in adolescents aged 13 to 15 years. Shuu-Jiun Wang, Jong-Ling Fuh, Kai-Dih Juang, Shiang-Ru Lu. Neurology Mar 2009, 72 (13) 1146-1152; DOI: 10.1212/01.wnl.0000345362.91734.b3
11. https://www.researchgate.net/profile/Richard-Lipton/publication/221690245_Migraine_Headaches_and_Suicide_Attempt/links/5bf32fb192851c6b27cadd27/Migraine-Headaches-and-Suicide-Attempt.pdf
12. https://www.cdc.gov/suicide/facts/index.html
13. https://news.va.gov/38022/veterans-who-deployed-are-more-likely-to-develop-migraines-or-headache-disorders/
14. Peroutka SJ, Price SC, Wilhoit TL, Jones KW. Comorbid migraine with aura, anxiety, and depression is associated with dopamine D2 receptor (DRD2) NcoI alleles. Mol Med. 1998 Jan;4(1):14-21. PMID: 9513185; PMCID: PMC2230268.
15. Liu HY, Fuh JL, Lin YY, Chen WT, Wang SJ. Suicide risk in patients with migraine and comorbid fibromyalgia. Neurology. 2015 Sep 22;85(12):1017-23. doi: 10.1212/WNL.0000000000001943. PMID: 26296516.
16. Abbar M, Demattei C, El-Hage W, Llorca P, Samalin L, Demaricourt P et al. Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial BMJ 2022; 376 :e067194 doi:10.1136/bmj-2021-067194
17. Zeifman RJ, Wagner AC, Watts R, Kettner H, Mertens LJ and Carhart-Harris RL (2020) Post-Psychedelic Reductions in Experiential Avoidance Are Associated With Decreases in Depression Severity and Suicidal Ideation. Front. Psychiatry 11:782. doi: 10.3389/fpsyt.2020.00782
18. Schindler E. Psychedelics and clinical trials: What is the data for primary headache disorders? Presented at: American Headache Society annual scientific meeting; June 9-12, 2022; Denver.
19. https://www.npr.org/sections/health-shots/2022/08/11/1116769071/social-media-posts-warn-people-not-to-call-988-heres-what-you-need-to-know

*The contents of this blog are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The writer does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.