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A Systematic Review and Meta-Analysis of Migraine and Suicidal Ideation

Friedman, Lauren E. PhD*; Gelaye, Bizu PhD, MPH*; Bain, Paul A. PhD; Williams, Michelle A. ScD*

The Clinical Journal of Pain: July 2017 - Volume 33 - Issue 7 - p 659–665
doi: 10.1097/AJP.0000000000000440
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Background: Previous studies have demonstrated an association between migraine and major depressive disorder. However, relatively little is known about the relationship between suicidal ideation, with or without concurrent depression, and migraine.

Objective: We conducted a systematic literature review to synthesize the available research focused on investigating the association of migraine with suicidal ideation.

Methods: Relevant research papers were identified through searches of major electronic databases including PubMed, Embase (Elsevier), Web of Science (Thomson Reuters), PsycINFO (EBSCO), and Google Scholar. We performed a meta-analysis to estimate the pooled unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (95% CI) for the association between migraine and suicidal ideation extracted from each study.

Results: A total of 148,977 participants in 6 studies were included in this analysis. Overall, findings from available studies documented elevated odds of suicidal ideation among individuals with migraines. In unadjusted models, the odds of suicidal ideation was 2.49-fold higher among individuals with migraine (OR, 2.49; 95% CI, 2.34-2.65) compared with those without migraine. In multivariate-adjusted models, the pooled adjusted OR of suicidal ideation was 1.31 (OR, 1.31; 95% CI, 1.10-1.55).

Conclusions: A meta-analysis of available studies suggests a modest positive association between migraine and suicidal ideation. Further studies allowing for a more comprehensive investigation of the association between migraine and the full range of suicidal behaviors are warranted. A larger and more robust evidence-base may be useful to inform the clinical screening and diagnoses of comorbid conditions in migraineurs.

*Department of Epidemiology, Harvard T. H. Chan School of Public Health

Harvard Medical School, Countway Library of Medicine, Boston, MA

Supported by awards from the National Institutes of Health (NIH), National Institute of Minority Health and Health Disparities (T37-MD-001449), and Eunice Kennedy Shriver Institute of Child Health and Human Development (R01-HD-059835), Boston MA. The NIH had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. The authors declare no conflict of interest.

Reprints: Lauren E. Friedman, PhD, Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave., K501 Boston, MA 02115 (e-mail: lfriedm@hsph.harvard.edu).

Received March 30, 2016

Received in revised form October 25, 2016

Accepted September 10, 2016

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