Migraines and suicide #MHAM #CDNmigraine

Suicide attempts are 3 times more likely in people with #Migraine with aura. #MHAM

Suicide attempts are 3 times more likely in people with #Migraine with aura. #MHAM

 

Pain itself is a suicide risk factor. Suicidal ideation and intent can happen when pain exceeds our coping strategies. Which happens when we have no pain management and we are exceeding our pain limits.

During the 2-year followup period, persons with migraine or severe headache were at least 4 times more likely to attempt suicide than controls. The odds ratio in migraineurs — adjusted for sex, psychiatric disorder, and previous history of suicide attempt at baseline — was 4.43 (95% Confidence Interval [CI] 1.93, 10.2). Persons with non-migraine headache of comparable intensity and disability also had a greatly increased likelihood of suicide attempt as compared with controls: odds ratio, adjusted for the same covariates, was 6.20 (95% CI 2.40, 16.0). [Due to the wide, overlapping CIs the difference between the 2 odds ratio estimates was not statistically significant.]

The likelihood of suicide attempt was not influenced by alcohol- or drug-use disorder, or by migraine with or without aura. However, the average pain intensity score of persons who attempted suicide during the follow-up period was significantly higher than in persons who did not attempt suicide: mean 7.58 (Standard Deviation [SD] = 2.75) on a 0-to-10 scale compared with 5.18 (SD = 3.70), respectively. Essentially, the risk of suicide attempt increased by 17% with each 1 point rise on the pain-intensity scale; or, in other terms, an increase in pain score of 1 SD unit raised the odds of suicide-attempt by 79% (OR = 1.79).

The researchers conclude that their study provides strong confirmation of previous reports on the increased risk of suicide attempts associated with migraine and other headache of comparable severity and disability. Pain severity appears to be a most important etiological factor in this association — more so than co-occurring depression or anxiety disorder, or other factors; therefore, pain-relieving strategies may be of primary importance in these patients. Pain-topics

I am in this statistic of suicidal ideation and intent. I have had two suicide attempts and given the amount of suicidal ideation during that time frame, I was lucky to have survived. Actually that first suicide attempt I was lucky to have survived because I was very intent on my demise. Had my brother not had unusual insomnia that night and found me, I wouldn’t be here. Because had my method not succeeded I would simply have persisted.

I can tell you why I ended up with suicidal intent. Suicidal ideation occurs when I am in a great deal of pain, the migraine itself causes a dip in emotions and suicidal ideation occurs. Depression being a common prodrome symptom for me. And in fact developed into depression related to chronic pain as well.

But suicidal intent is another matter. When I crossed the line from thought to planning to action was a few factors. I have chronic daily migraines with aura. I had no effective preventative medication. I had no rescue medication. Triptans cause a great deal of side effects so I cannot take them even the three days a week permitted so I was left with a great deal of pain to endure while working. I was missing a lot of work. I was going on leaves of absence Frequently but nothing was changing as a result of them… except my work environment was getting worse. My work environment was stressful and my employer was not exactly understanding of the pain I was in, but the who would want an employee that missed work frequently? My doctor was disinterested in my care and rather ignored me when I said I was struggling to cope with the pain… and I am very stoic when it comes to pain (not a lot of people can even tell I am in pain unless it really gets up there) so I believe he simply failed to acknowledge my Words. Which given practically my whole life has been in chronic pain one should comprehend a person develops the ability to mask it pretty effectively. My neurologist had said there was nothing more that could be done for me. And then the final factor, the straw that broke the camels back as it were, I respond very poorly to antidepressants and was put on Cymbalta for FM and migraines which caused far More suicidal ideation than I was already having.

I have no idea why migraines with aura increases the chances of suicide attempts but I do know exceeding my pain limits but me in a very extreme danger zone for suicidal ideation and intent. It was a dark time that lasted years. Treatment didn’t change you see. And here in Canada I wasn’t seeing a neuro regularly at all, so even if change did happen it would have been infinitely slow. Nor do we even have migraine specialists so it is luck of the draw with neurologists… some with so little knowledge I easily surpassed them. The prodrome depression I was getting was a severe drop in mood with a migraine. A plummet. That would endure with status migraines. In fact with status migraines I would say I was at the highest risk for suicidal intent and both my attempts occurred during them. The pain gets to a person when you are stuck in that severity for a week or more. Not to mention the sleep deprivation.

It is a serious matter. Pain. And it isn’t addressed well at all. Push through it? Endure it. Deal with it. How many years can you live in survival mode? A question I asked myself many times. And it seemed like madness, that existence, and my participation in it.

Things that changed this scenario have been:

a) changing my doctor first and foremost to one that actually listens to me

b) that doctor sending me to the pain clinic

c) that pain clinic putting me on Tramadol

d) seeing a psychologist who specializes in pain

e) that pain clinic forcing me to understand I cannot work full-time

f) changing to part-time

g) going on a non antidepressant mood medication

I don’t think anyone will be able to understand the raw desperation I felt during that time. The lack of hope. The pure suffering. This lack of a life… this existence that was just struggling and crawling through the pain to get home and finally be able to be in pain in some peace. This life of inches, where ever moment of pain is a struggle earned. Not being able to sleep though because of the pain levels. Being sleep deprived. Getting into status migraine cycles as a result. Wishing for death of any sort. That is not a life worth living. And all that suffering is madness that no one acknowledged. I would go on a leave of absence and get this blissful break in the immensity of the suffering only to be told that migraines are just not that big of a deal. And my doctor would want me to return to work full-time… pushing me to do so. And I would just despair inside. After the first suicide attempt I when on a leave of absence for ‘stress’ and was pushed to return to full-time work in three months. I realized then that no amount of suffering mattered. That there was literally no hope. I am fortunate my mother pushed me to change doctors and that my spouses doctor took in relatives patients (doctor shortage in this area). My psychologist says most people after a suicide attempt are glad they survived, but I was numb. And ambivalent. I still had exactly the same circumstances and all that pain wasn’t going anywhere.

And that pain hasn’t gone anywhere. I still have it. But I am no longer pushing beyond my limits. I work a day, I have a day off. If one day is horrific in pain I know I have a day of rest. I no longer have sleep deprivation so I avoid most of the status migraine cycles. I have pain management to help me develop alternative ways to cope with the pain levels that will always exist. The idea being to reduce the suffering, because the pain will Be there. And of course medication to manage the deeper mood dips I was experiencing when in extreme pain, which helps. Because when I am in extreme pain my mood did plummet like a rock… and now it dips but I know what to do to cope with that.

Here is the thing. Poorly managed pain is a risk factor for suicide. And these days pain is poorly managed. I fear being in that mental place again to be honest. It was recent enough that the wound still is fresh in my mind. I know the feeling well. I know what it feels like to go through the motions of life but to not want to exist with the pain anymore. I know the feeling that this pain existence is just madness and that participating in this madness just doesn’t even make logical sense anymore. And I still wonder how the medical community think this is fine. I still fear my capacity to endure this pain long term. Insidious thoughts still haunt me as much as the pain haunts my existence.

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