Increased suicidal attempts and risks of ideation in medication-overuse headache

Medication-overuse headache (MOH) is associated with an increased risk of suicidal ideation and increased prior suicide attempts in patients with chronic migraine. This was found in a cross-sectional study from Taiwan presented at the IHC 2021 and recently published in The Journal of Headache and Pain [1,2]. So, paying special attention to the risks of suicide is imperative in the management of patients with MOH.

MOH is a secondary headache disorder resulting from excessive use of acute medications for a prolonged period of time. Behaviours of substance dependence are common among patients with MOH [3]. “More than two-thirds of patients with MOH can fulfil the criteria for substance dependence,” Dr Yen-Feng Wang (Taipei Veterans General Hospital, Taiwan) added. “Besides, substance use disorders and chronic pain disorders, including migraine, are associated with increased suicidal risks [4].” However, the potential risks of suicide in MOH are unknown.

In this prospective, cross-sectional study, 603 patients with chronic migraine (485 women; mean age 42) were recruited, including 320 patients with MOH (257 women) [1]. Patients with MOH were significantly younger at migraine onset (20.7 vs 23.0 years; P=0.004). Despite comparable headache frequencies in patients with or without MOH (23.3 vs 22.4; P=0.098), patients with MOH had higher monthly analgesic use (19.4 vs 4.5 days per month; P<0.001). In contrast, the presence of disease-related disability symptoms such as anxiety, depression, and sleep quality was comparable between patients with or without MOH.

Among patients with chronic migraine, patients with MOH were more likely to have suicidal ideation and prior suicide attempt (see Figure). “However, it is important to exclude the possibility of potential confounders,” Dr Wang added. After controlling for demographics, headache profile, disabilities, symptoms of anxiety and depression, and sleep quality, the OR for suicidal ideation was 1.75 (P=0.004) and the OR for prior suicide attempt was 1.88 (P=0.024).

Figure: Proportion of individuals with suicidal ideation and prior suicide attempt in patients with or without MOH [1]

1. Wang YF, et al. Association between suicidal risks and medication-overuse headache in chronic migraine: a cross-sectional study. AL015, IHC 2021, 8–12 September.
2. Wang YF, et al. J Headache Pain. 2021;22(1):36.
3. Radat F, et al. Headache. 2008;48(7):1026–36.
4. Yuodelis-Flores C, Ries RK. Am J Addict. 2015;24(2):98–104.

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Posted on 8 November 202123 April 2024