Suicidal ideation and risk factors in Korean migraine patients

Population-based studies have reported an increased risk of suicidal ideation in patients with migraine. However, there is some controversy as to whether migraine itself is a risk factor for suicidal ideation after adjusting for psychiatric comorbidities. We calculated the frequency of suicidal ideation among patients with migraine visiting a tertiary care hospital and determined its risk factors. Patients with migraine and healthy controls completed self-report questionnaires to assess depression, anxiety, and suicidal ideation, and the frequency of suicidal ideation. Risk factors for suicidal ideation were investigated in terms of demographic, clinical, and psychiatric variables. One hundred eighty-five patients with migraine (156 females and 29 males; mean age 39.1 years) and 53 age and education-matched healthy controls participated in the study. The frequency of suicidal ideation was significantly greater in patients with migraine than healthy controls (odds ratio [OR]=5.09, 95% confidence interval [CI] 1.17-22.10, p=0.003), but this significance was not sustained after adjusting for comorbid depression and anxiety. The risk of suicidal ideation in patients with migraine was associated with lower education levels, higher frequency of migraine attacks, stronger intensity of headaches, and presence of phonophobia, chronic migraine, depression, and anxiety. The strongest predictor was depression (OR=15.36, 95% CI 5.39-43.78, p<0.001), followed by the intensity of headache while completing the questionnaire (OR=1.293, 95% CI 1.077-1.553; p=0.006). The contribution of migraine-specific variables to suicidal ideation is trivial compared to that of depression and headache intensity.