Associations of migraines with suicide ideation or attempts: A meta-analysis

Risks and familial coaggregation of suicide, accident mortality, and psychiatric disorders in first-degree relatives of individuals with migraine

Studies have revealed a comorbidity to be common between patients with migraine and those with psychiatric disorders, such as bipolar disorder (BD) and major depressive disorder (MDD). However, considering the substantial epidemiological differences in the prevalence of migraine between Western and Asian countries, further investigation was required to determine whether findings regarding familial coaggregation of migraine and psychiatric disorders can be generalized to Asian populations. Using the Taiwan National Health Insurance Database, we included 822,773 first-degree relatives (FDRs) of individuals with migraine and 3,291,092 FDRs of individuals without migraine. We investigated the prevalence of nine psychiatric disorders-schizophrenia, BD, MDD, autism, attention deficit hyperactivity disorder (ADHD), alcohol use disorder (AUD), substance use disorder (SUD), generalized anxiety disorder (GAD), and panic disorder (PD)-in addition to suicide and accidental death in these individuals. Poisson regression models with robust error variance revealed that the FDRs of individuals with migraine were at higher risks of suicide (relative risk: 1.11) as well as BD (1.09), MDD (1.16), autism (1.08), ADHD (1.23), AUD (1.20), SUD (1.14), GAD (1.23), and PD (1.26) than were those of individuals without migraine. The concurrent presence of psychiatric disorders, migraine, and suicide within families suggests a shared pathomechanism across these medical conditions. Thus, clinicians should closely monitor the mental health of FDRs of individuals with migraine. PERSPECTIVE: First-degree relatives of migraine probands had an increased risk of being diagnosed with psychiatric disorders, including schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders, and alcohol or substance use disorders. They also died by suicide, regardless of the individual migraine and psychiatric comorbidities.

Effect of migraine on suicide mortality in young adults: a nationwide cohort study in South Korea

BACKGROUND

Migraine is linked to increased suicidal behaviour, but its relationship with suicide mortality remains underexplored. In South Korea, suicide rates are among the highest in Organisation for Economic Co-operation and Development nations, particularly in young adults.

OBJECTIVE

To investigate the effect of migraine on suicide mortality in young Korean adults.

METHODS

Participants who underwent the Korean Health Examination from 2009 to 2012 were enrolled in this study and followed up until 2021. Participants aged 20-39 years (n=6 539 547) were categorised based on their migraine status. Cox proportional hazards regression models assessed the association between migraine and suicide mortality, adjusting for demographic factors, health behaviours and comorbidities.

FINDINGS

Among 6 539 547 participants, 113 681 (1.74%) had migraine (6620 (0.10%) with aura, 107 061 (1.64%) without aura). Over 11 years, there were 21 suicides (0.32%) in migraine with aura, 219 (0.20%) in migraine without aura and 13 040 (0.20%) in no migraine. All migraine was not linked to increased suicide risk (HR 1.07, 95% CI 0.94 to 1.21), but migraine with aura showed a higher risk (HR 1.61, 95% CI 1.05 to 2.47). Migraine without aura had no increased risk (HR 1.03, 95% CI 0.90 to 1.18). Depression modified the association across migraine subtypes.

CONCLUSION AND IMPLICATIONS

Although all migraine and migraine without aura were not significantly associated with a higher suicide risk compared with that in the absence of migraine, migraine with aura was associated with a higher risk of suicide mortality. Depression significantly modified this relationship, showing different associations across migraine subtypes.

Exploring infodemiology: unraveling the intricate relationships among stress, headaches, migraines, and suicide through Google Trends analysis

Introduction

Google Trends has emerged as a vital resource for understanding public information-seeking behavior. This study investigates the interconnected search trends of stress, headaches, migraines, and suicide, highlighting their relevance to public health and mental well-being. By employing infodemiology, the study explores temporal and geographical patterns in search behavior and examines the impact of global events like the COVID-19 pandemic.

Methods

Data mining was conducted using Google Trends for the search terms "stress," "headache," "migraine," and "suicide." Relative Search Volume (RSV) data from October 2013 to October 2023 was collected and adjusted for time and location. Statistical analyses, including Pearson correlation tests, linear regression, and seasonal Mann-Kendall tests, were applied to identify correlations, trends, and seasonal variations. Geographical differences were also analyzed to understand regional disparities.

Results

Significant correlations were observed among the search terms, with "migraine" and "suicide" showing the strongest association. Seasonal variations revealed a peak in search volumes during winter months. Geographical analysis highlighted consistently high RSV in the Philippines for all terms. During the COVID-19 pandemic, searches for stress, headaches, and migraines showed notable increases, reflecting heightened public interest in mental health-related topics during this period.

Discussion

The study underscores the interconnected nature of stress, headaches, migraines, and suicide in public search behavior. Seasonal patterns and regional variations emphasize the need for targeted interventions. The observed surge in search volume during the COVID-19 pandemic highlights the profound impact of global crises on mental health and the importance of timely public health responses.

Conclusion

Google Trends provides valuable insights into the public's interest in health-related topics, demonstrating the intricate relationship between stress, headaches, migraines, and suicide. The findings highlight the need for increased mental health awareness and interventions, particularly during times of heightened stress. Further research is essential to develop strategies that mitigate the impact of these stressors on public health.

A Drug-Drug Interaction Study to Evaluate the Impact of Rimegepant on OCT2- and MATE1-Mediated Transport of Metformin in Healthy Participants

Rimegepant is a calcitonin gene-related peptide receptor antagonist approved for migraine treatment. This phase 1, open-label, single-center, fixed-sequence study evaluated the effect of rimegepant on the pharmacokinetics (PK) of metformin. Twenty-eight healthy participants received metformin 500 mg twice daily from Days 1 to 4 and Days 7 to 10, and once daily on Days 5 and 11. Rimegepant, 75 mg tablet, was administered once daily from Days 9 to 12. At pre-specified time points, plasma metformin concentration, serum glucose levels, and safety and tolerability were evaluated. A 16% increase in the area under the plasma metformin concentration-time curve (AUC) for 1 dosing interval (AUC0-τ,ss), a statistically insignificant increase in maximum and minimum steady-state metformin concentration (Cmax,ss and Cmin,ss), and a decrease in metformin renal clearance were observed on Day 11 following metformin-rimegepant coadministration compared with metformin alone; however, the changes were not clinically relevant. Additionally, coadministration of rimegepant with metformin did not induce clinically meaningful change in the maximum observed glucose concentration (Gmax) or AUCgluc compared with metformin alone. Overall, rimegepant and metformin coadministration did not result in clinically relevant changes in metformin PK, renal clearance, or the antihyperglycemic effects of metformin. Rimegepant is considered safe for use with metformin.

The Pharmacokinetics, Safety, and Tolerability of Rimegepant 75 mg Are Similar in Elderly and Nonelderly Adults: A Phase 1, Open-Label, Parallel-Group, Single-Dose Study

Rimegepant is a small-molecule calcitonin gene-related peptide receptor antagonist approved for the acute treatment of migraine ± aura and preventive treatment of migraine in adults. The pharmacokinetics of rimegepant in elderly and nonelderly subjects were evaluated. In an open-label Phase 1 study, 14 elderly (aged 65 years or older) and 14 nonelderly (aged 18 to less than 45 years) subjects each received a single oral dose of rimegepant 75 mg. Blood samples were collected before dosing and through 96 hours after dosing. The pharmacokinetic parameters of rimegepant after a single dose were similar in both age groups. Geometric least-squares mean ratios (elderly/nonelderly) of the natural log-transformed maximum observed plasma concentration and natural log-transformed area under the plasma concentration-time curve from time 0 extrapolated to infinity were 96.6 and 104.6, respectively. Eight (28.6%) subjects (4 elderly, 4 nonelderly) experienced 1 or more adverse events (AEs); all AEs were mild in intensity, and no serious AEs or AEs leading to discontinuation were reported. Following a single 75-mg dose of oral rimegepant, pharmacokinetic parameters were similar in elderly and nonelderly adults; no dose adjustment is warranted in elderly subjects.