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Headache May Predict Link Between Suicide
and Psychiatric Disorders In Youth
Wang SJ, Juang KD, Fuh JL, Lu SR.
Posted: July 2007  
Neurology 2007;68:1468-1473

Adolescents with chronic daily headache may have a high comorbidity of psychiatric disorders and suicide risk, according to Shuu-Jiun Wang, MD, and colleagues. Their results, published in the May 1 Neurology, show that the presence of migraine attacks, especially migraine with aura, was the major predictor for the association between psychiatric disorders and risk of suicide.

A total of 121 subjects (age 12 to 15; 90 females) with chronic daily headache underwent psychiatric interviews. Eighty-one of the participants had migraine or probable migraine, 67 had migraine without aura, and 14 had migraine with and without aura. Fifty-seven of the participants had at least one depressive or anxiety disorder; major depression and panic disorder were the two most prevalent diagnoses. The researchers found that current suicide risk was high in 20% of the participants and that female gender and older age were associated with depressive disorders. Presence of migraine was also associated with psychiatric comorbidities. The association between migraine and psychiatric comorbidities was stronger when migraine included aura than when it did not. Migraine with aura was also an independent predictor of high risk of suicide, and no correlations between chronic daily headache, headache frequencies, or medication overuse with high risk of suicide were observed.

"Intriguingly, migraine with aura has seldom been raised as an issue in patients with chronic daily headache since most headache experts believe that patients with chronic migraine usually have migraine without aura," Dr. Wang and colleagues noted. "This concept is also demonstrated in the diagnostic criteria of chronic migraine, in which only the frequencies of migraine without aura are counted...We suggest that the role of migraine with aura should be emphasized in adolescents with chronic daily headache for its high comorbidities."

The investigators acknowledged that the prediction of suicide among youth is "highly difficult" and that short-term structured suicidal evaluations may be of limited use for clinical applications. However, "without exploration of ...psychiatric disorders, adolescents with chronic daily headache may focus more on their physical disability caused by headaches rather than emotional/mental disability," Dr. Wang’s team stated. "Therefore, psychiatric comorbidity should be carefully explored and managed in each adolescent with chronic daily headache."