Association between suicidal risks and medication-overuse headache in chronic migraine: a cross-sectional study

DOI: https://doi.org/10.1186/s10194- 021- 01248- 0

Abstract-Summary Headache diagnoses were made through face-to-face interviews by headache spe- cialists, and a specifically designed questionnaire was used to collect demographics,

3.5 Medication Overuse and Addiction

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headache profiles, Migraine Disability Assessment, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, etc Suicidal ideation and prior suicide attempt were specifically questioned.

603 CM patients (485F/118M, mean age 42.03 ± 12.18 years) were recruited, including 320 with MOH (257F/63M, mean age 42.8 ± 11.7 years) (53.1%), and 214 (35.5%) and 81 (13.4%) had suicidal ideation and prior suicide attempt, respectively. Among CM patients, the presence of MOH increased the risks of suicidal ide- ation (odds ratio [OR] = 1.75 [95% CI = 1.20–2.56], p = 0.004) and prior suicide attempt (OR = 1.88 [1.09–3.24], p = 0.024), after controlling for demographics, headache profile, disabilities, symptoms of anxiety and depression, and sleep quality.

In CM patients, MOH is associated with an increased risk for suicidal ideation and prior suicide attempt, which deserves attention for clinicians taking care of headache patients.

Extended: Among CM patients, the presence of MOH was associated with increased risks of suicidal ideation (OR = 1.71 [95% CI = 1.22–2.41], p = 0.002) and prior suicide attempt (OR = 1.78 [1.10–2.92], p = 0.019).

Background Patients with migraine and other chronic pain disorders are at increased risks for suicidal ideation or attempts [594–599].

The underlying mechanisms are uncertain, although reports on patients with alcohol use disorders suggested that comorbid depression is an important risk factor for suicide [600, 601].

Since two thirds of MOH patients could fulfill the criteria for substance depen- dence [520, 602], it could be hypothesized that MOH could share some clinical features with substance use disorders, including suicidal risks, and whether symp- toms of depression or anxiety could have a role deserves exploration.

The primary objective of the present study is to compare the suicidal risks between CM patients with and without coexisting MOH, as well as to determine whether psychiatric comorbidities could be involved in the association between MOH and suicidal risks.

Methods In this cross-sectional study, consecutive patients newly diagnosed with CM with or without a coexisting diagnosis of MOH were enrolled prospectively from the Headache Clinic of Taipei Veterans Hospital.

Patients were included if they were (a) willing to participate in the study, (b) aged

between 20 and 65 years, and (c) fulfilling the ICHD-3 criteria for CM.

The exclusion criteria included (a) an acute headache disorder (within one month of headache onset), (b) a secondary headache disorder, and (c) difficulties complet- ing history taking or questionnaire-based interview.

The questionnaire was designed to collect the demographic and clinical charac- teristics of headache patients, and included general data, past medical and surgical histories, general physical condition, headache characteristics, medication use, psy- chological disturbances, etc Headache-related disability was measured by using

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3 Diagnosis

Migraine Disability Assessment (MIDAS), and moderate and severe disability was defined as MIDAS sore ≥ 11 [603]. Results Period, 2736 consecutive headache patients (1924F/812M, mean age 41.41 ± 13.38 years, range 20–65) were screened at their first visit, and 2107 were excluded for diagnosis other than CM.

Besides, there was a trend toward an older age (mean age 42.8 ± 1.7 vs. 41.2 ± 12.7 years, p  =  0.093), higher headache frequencies (23.3  ±  6.9 vs. 22.4  ±  7.4, p = 0.098) in MOH patients.

Among CM patients, the presence of MOH was associated with increased risks of suicidal ideation (OR = 1.71 [95% CI = 1.22–2.41], p = 0.002) and prior suicide attempt (OR = 1.78 [1.10–2.92], p = 0.019).

Discussion An association between MOH and suicidal risks was identified.

As MOH share many clinical features of substance use disorders [520, 602], the findings of the current study were actually in keeping with those in the WMHS, although suicidal risks in MOH were not as high as those in substance use disorders. Besides, suicidal risks were found to be associated with compromised quality of

life in patients with chronic daily headache (CDH) and MOH [604].

It is important to be alert to the potential risk of suicide in taking care of patients

with MOH.

The causal relationship could be further investigated by longitudinal studies involving MOH patients without prior suicidal ideation or attempt at baseline, and new-onset suicidal ideation or attempt at follow-up would help determine the cau- sality or directionality of the association.

Conclusions The present study identified an association between MOH and suicidal risks in patients with CM, suggestive of a potential link between behaviors of dependence and suicide.

The potential risks of suicide should not be overlooked in clinical practice for

clinicians taking care of patients with MOH.

Acknowledgement A machine generated summary based on the work of Wang, Yen-Feng; Yu, Chia- Chun; Kuan, Ai Seon; Chen, Shih-Pin; Wang, Shuu-Jiun. 2021 in The Journal of Headache and Pain.

Use and overuse of triptans in Austria – a survey based on nationwide healthcare claims data