Abstract
BackgroundBehaviors of substance dependence are common among patients with medication-overuse headache (MOH). Whether MOH, like other substance use disorders, is associated with an increased risk for suicide is unknown.MethodsIn this cross-sectional study, newly diagnosed chronic migraine (CM) patients with or without coexisting MOH were enrolled prospectively. Headache diagnoses were made through face-to-face interviews by headache specialists, and a specifically designed questionnaire was used to collect demographics, headache profiles, Migraine Disability Assessment, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, etc. Suicidal ideation and prior suicide attempt were specifically questioned.ResultsIn total, 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 ideation (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.ConclusionsIn 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. However, further studies are needed to determine the causal relationship, as well as the underlying pathophysiology.
Highlights
Behaviors of substance dependence are common among patients with medication-overuse headache (MOH)
The primary objective of the present study is to compare the suicidal risks between chronic migraine (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
The presence of MOH was associated with increased risks for suicidal ideation (OR = 1.75 [95% Confidence interval (CI) = 1.20–2.56], p = 0.004) and suicide attempt (OR = 1.88 [1.09–3.24], p = 0.024), and the association was not accounted for by potential confounders, including demographics, headache profiles, migraine-related disability, psychiatric comorbidities, or sleep quality (Table 2)
Summary
Behaviors of substance dependence are common among patients with medication-overuse headache (MOH). Whether MOH, like other substance use disorders, is associated with an increased risk for suicide is unknown. Patients with migraine and other chronic pain disorders are at increased risks for suicidal ideation or attempts [16,17,18,19,20,21]. The underlying mechanisms are uncertain, reports on patients with alcohol use disorders suggested that comorbid depression is an important risk factor for suicide [27, 28]. Since two thirds of MOH patients could fulfill the criteria for substance dependence [29, 30], it could be hypothesized that MOH could share some clinical features with substance use disorders, including suicidal risks, and whether symptoms of depression or anxiety could have a role deserves exploration
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