title: Migraine headache and risk of self-harm and suicide: A population-based study in Ontario, Canada.
abstract: BACKGROUND
  Migraine has been associated with mental illness, and may also be associated with increased risk of suicidal behavior.
  
  
  OBJECTIVE
  The aim of this article was to examine the association between migraine headache and self-harm and suicide mortality using population-based health administrative data from Ontario, Canada.
  
  
  METHODS
  The sample included 101,114 participants in a population-based health survey in the province of Ontario, Canada, who responded to the survey in 2003, 2005, or 2007, and provided health card numbers for linkage to population-based health administrative data. Participants self-reported a physician diagnosis of migraine headache. Heath administrative data were used to calculate (1) Follow-up time until first presentation to the emergency department for intentional self-harm; (2) Follow-up time until death by suicide. Proportional subdistribution hazards regression was used to compare time until death among those with and without history of migraine, after accounting for competing risks of death and adjusting for confounders.
  
  
  RESULTS
  Physician diagnosis of migraine was reported by 11.2% of the sample (11,314 individuals). Mean follow-up time was 7.3 years. Emergency department visits for self-harm during the follow-up period were almost 50% more likely in those with migraine (76.4 vs 35.7 per 100,000 person years; adjusted hazard ratio = 1.48; 95%CI: 1.11,1.96). Death by suicide was rare with only 55 suicides in the follow-up period (7.45 per 100,000 person-years). Risk of suicide was similar for both those with and without history of migraine headache (adjusted hazard ratio=0.60; 95%CI: 0.22,1.65).
  
  
  CONCLUSIONS
  Physician diagnosis of migraine headache was found to be prospectively associated with increased risk of deliberate self-harm, but there was no evidence linking it to suicide mortality. Definitively linking migraine to death by suicide may require very large samples. Health care professionals should consider monitoring suicidal risk in individuals with migraine headache.
authors.affiliation: Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Colman
authors.affiliation: Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Mila
authors.initials: M
authors.lastname: Kingsbury
authors.affiliation: Department of Psychiatry, University of Manitoba, Winnipeg, Canada.
authors.forename: Jitender
authors.initials: J
authors.lastname: Sareen
authors.affiliation: Department of Psychiatry, University of Manitoba, Winnipeg, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Bolton
authors.affiliation: Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada.|Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Carl
authors.initials: C
authors.lastname: van Walraven
mesh_terms: D000328:Adult; D000368:Aged; D018672:Community Health Planning; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology* / Q000523:psychology*; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: headache; migraine; self-harm; suicidal behavior; suicide