Association Between Migraine and Suicidal Behaviors: A Nationwide Study in the USA

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.

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.

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, 9^th 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).

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).

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.