Migraine and suicidal ideation in adolescents aged 13 to 15 years.Neurology 2009; 72(13):1146-52Neur
Awareness is growing among clinicians of the importance of suicidal ideation in adolescents.
To investigate the relationship between migraine and suicidal ideation in a nonreferred sample of adolescents.
This study surveyed migraine and depression in three middle schools in Taitung County, Taiwan. All students completed the questionnaires, including demographics, a validated headache questionnaire, the Adolescent Depression Inventory (ADI), and the Pediatric Migraine Disability Assessment (PedMIDAS) questionnaire. This study used the presence or absence of suicidal ideation as indicated by the ADI for the analysis.
A total of 3,963 (2,040 male and 1,923 female; mean age 14.0 +/- 0.9 years) adolescents (93% of the target cohort) completed this study. Suicidal ideation was reported in 8.5% of the study group. Compared with nonmigraine subjects (6.2%), subjects with migraine displayed a higher frequency of suicidal ideation (16.1%; odds ratio [OR] = 2.9, 95% confidence interval [CI] 2.3-3.6; p < 0.001), especially those with migraine with aura (23.9%; OR = 4.6 [95% CI 3.0-7.0]; p < 0.001). Suicidal ideation was associated with higher headache frequency and headache-related disability as measured by the PedMIDAS. After controlling for depression score and sociodemographic characteristics, the association remained only for migraine with aura (adjusted OR = 1.79 [95% CI 1.07-2.99]; p = 0.025) and high headache frequency (>7 days/month; adjusted OR = 1.69 [95% CI 1.12-2.56]; p = 0.013) but not for migraine without aura or probable migraine or PedMIDAS score.
This study identified a higher frequency of suicidal ideation in younger adolescents with migraine with aura or high headache frequency. These associations were independent of depressive symptoms. ADI = Adolescent Depression Inventory; AOR = adjusted odds ratio; CI = confidence interval; 5-HT = serotonin; ICHD-2 = International Classification of Headache Disorders, Second Edition; MINI-Kid = Mini-International Neuropsychiatric Interview-Kid; OR = odds ratio; PedMIDAS = Pediatric Migraine Disability Assessment.