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Chronic Headache & Migraine Summit

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03 June 2012

Stigma of Migraine and Suicide


Stigma of Migraine Disease
  • Migraineurs represent one of the most stigmatized groups in society
  • Seen as complainers, hypochondriacs, weaklings or lazy
  • Seen as having “just a headache”
  • Chronic sufferers experience worse stigma than episodic sufferers
  • Results in depression, anxiety, decreased quality of life, and disruption of social relationships
  • Each attack is different and no diagnostic tool exists to prove it exists
  • Feel more stigmatized than people with other neurological disorders such as MS, stroke, and epilepsy
    • Feel more abandoned, mocked, and isolated
  • There are some medical experts who don’t understand or even recognize Migraine as a disease

Stigma of Mental Illness
  • People assume you are unstable, violent or dangerous because of having a mental health condition
  • Lack of understanding by family, friends, colleagues or others you know
  • Discrimination at work
  • Difficulty finding housing
  • Bullying, physical violence or harassment
  • Health insurance that doesn’t adequately cover your mental illness
  • The belief that you will never succeed at certain challenges or that you can’t improve your situation
  • Depression is the most feared mental illness
  • Major Depression Disorder (MDD) is the most common mood disorder and largely misunderstood

Coping With Stigma
  • Get treatment
  • Don’t let stigma create self-doubt or shame
  • Don’t isolate yourself
  • Don’t equate yourself with your illness
  • Join a support group
  • Get help at school
  • Speak out against stigma

Depression and Migraine Disease

Eighteen (18%) of migraine sufferers also have Major Depression Disorder (MDD).  Some researchers believe there may be a genetic connection between migraine and depression.  Physiologically, genes involved in both conditions could affect molecular pathways.  Research suggests that both diseases share glutamate and serotonin pathways, two of the brain’s key chemicals.  According to the NHF (National Headache Foundation):
  • People with headaches can develop psychological symptoms
  • People with depression can also develop physical symptoms
  • Headaches caused by underlying depression can be identified as:
    • Headaches that tend to be worse in the morning and evening
    • Depressed people who say their headaches lasts for years or for their entire lives
    • Occur at regular intervals – weekends, holidays, or first day of vacation
    • Usually having a steady, non-pulsing ache that feels like a band around the head or a vise-like grip
  • Physicians should work with a psychotherapist
    • Recommends smaller doses of tricyclic antidepressants (Elavil); they work better for these types of headaches rather than selective serotonin reuptake inhibitors (SSRIs) like Zoloft or Lexapro
    • Different tricyclics can be prescribed to patients that have migraines, depression, and insomnia
  • Seventy (70%) of people with the migraine-depression combination also have sleep disturbances
 
Twenty six (26%) of people with bipolar disorder also experienced frequent migraine attacks.  Migraine with aura (MA) patients are more likely to have multiple anxiety disorders, depression, and hypomania compared to Migraine without aura (MwoA) patients.  Scientists speculate that various dysfunctions in the brain, i.e. bipolar disorder, produce other brain dysfunctions like depression, seizures, and Migraine with aura (MA).

Migraine and Suicide Risk
  • High correlation of emotional problems explains higher than average suicide rate
  • Suicide rate is higher than it is in the general population
  • Females with MA have highest suicide rate
  • People with most severe and frequent attacks will most likely contemplate suicide
  • People who have MwoA are just as likely to contemplate suicide as those with MA but less likely to act upon suicide ideation
  • No significant risk of suicide in people with Chronic Daily Headache (CDH)

Medication and Suicide Risk
  • Some evidence shows that anticonvulsants may contribute to the high suicide rate among migraineurs
  • These following drugs are associated with high suicidal tendencies, as compared to topiramate (Topamax):
    • Gabapentin (Neurontin) – 40% higher risk than Topamax
    • Lamotrigine (Lamictal)
    • Oxcarbazepene (Trileptal)
    • Tiagabine (Gabatril)
In a study published by the Journal of the American Medical Association (JAMA), nearly 300,000 people who suffer from migraines, chronic pain, bipolar disorder, and epilepsy began taking one of 13 anticonvulsants.  None of the participants had any history of suicidal behavior.
After approximately 180 days, 26 patients committed suicide, and 801 attempted suicide.
Gabapentin, which is associated with the highest risk of suicide, is also one of the most frequently prescribed anticonvulsants for migraines (48%), followed by Topiramate (19.4%), Lamotrigine (7.5%), and Valproate (6.2%).[1]

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[1] Patorno E, Bohn RL, Wahl PM, et al. Anticonvulsant medications and the risk of suicide, attempted suicide, or violent death. JAMA. 2010;303(14):1401-1409.


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WORLD SUICIDE PREVENTION DAY, September 10th, is an opportunity for all sectors of the community - the public, charitable organizations, communities, researchers, clinicians, practitioners, politicians and policy makers, volunteers, those bereaved by suicide, other interested groups and individuals - to join with the International Association for Suicide Prevention and the WHO to focus public attention on the unacceptable burden and costs of suicidal behaviours with diverse activities to promote understanding about suicide and highlight effective prevention activities.
Those activities may call attention to the global burden of suicidal behaviour, and discuss local, regional and national strategies for suicide prevention, highlighting cultural initiatives and emphasising how specific prevention initiatives are shaped to address local cultural conditions. Initiatives which actively educate and involve people are likely to be most effective in helping people learn new information about suicide and suicide prevention. Examples of activities which can support World Suicide Prevention Day include:
  • Launching new initiatives, policies and strategies on World Suicide Prevention Day
  • Holding conferences, open days, educational seminars or public lectures and panels
  • Writing articles for national, regional and community newspapers and magazines
  • Holding press conferences
  • Placing information on your website and using the IASP World Suicide Prevention Day banner, promoting suicide prevention in one's native tongue (Over 50 banners in various languages were created last year)www.iasp.info/wspd/2012_wspd_banner.php
  • Securing interviews and speaking spots on radio and television
  • Organizing memorial services, events, candlelight ceremonies or walks to remember those who have died by suicide
  • Asking national politicians with responsibility for health, public health, mental health or suicide prevention to make relevant announcements, release policies or make supportive statements or press releases on WSPD
  • Holding depression awareness events in public places and offering screening for depression
  • Organizing cultural or spiritual events, fairs or exhibitions
  • Organizing walks to political or public places to highlight suicide prevention
  • Holding book launches, or launches for new booklets, guides or pamphlets
  • Distributing leaflets, posters and other written information
  • Organizing concerts, BBQs, breakfasts, luncheons, contests, fairs in public places
  • Writing editorials for scientific, medical, education, nursing, law and other relevant journals
  • Disseminating research findings
  • Producing press releases for new research papers
  • Holding training courses in suicide and depression awareness
  • Becoming a Facebook Fan of the IASP (www.facebook.com/IASPinfo)
  • Show your participation by clicking "attending" on the Official 2012 World Suicide Prevention Day Facebook Event page
  • Following the IASP on Twitter (www.twitter.com/IASPinfo), tweeting #WSPD or #suicide or #suicideprevention
  • Creating a video about suicide prevention (www.youtube.com/IASPinfo)
  • Lighting a candle, near a window, at 8 PM in support of: World Suicide Prevention Day, suicide prevention awareness, survivors of suicide and for the memory of loved lost ones
Works Cited

Andrews, Linda W. "Migraines and Depression: What's the Link?" Yahoo! Health. Yahoo!, 24 Feb. 2012. Web. 28 May 2012. .
 
Bonk, Nancy H. "Migraine and Stigma: High Impact - Migraine." HealthCentral.com. Remedy Health Media, 23 May 2011. Web. 28 May 2012. .
 
Martiello, Laura. "Stigma of Migraine Is Significant; Worse for Those with Chronic Migraine." Stigma of Migraine Is Significant; Worse for Those with Chronic Migraine. EurekAlert!, 23 June 2010. Web. 28 May 2012. .
 
"Migraine: Fighting the Stigma of Migraine." Migraine Association of Ireland. Ed. Editorial Board. Migraine Association of Ireland. Web. 28 May 2012. .
Staff, Mayo Clinic. "Mental Health: Overcoming the Stigma of Mental Illness." Mayo Clinic. Mayo Foundation for Medical Education and Research, 26 May 2011. Web. 28 May 2012. .
 
"Suicide Rate in Migraine Patients- Some Surprising Statistics | Migravent." Migravent. Migravent, 20 Jan. 2012. Web. 28 May 2012. .
 
Yoffee, Lynn, and Kevin Hwang, MD, MPH. "The Headache-Depression Connection." EverydayHealth.com. Everyday Health, 4 Nov. 2011. Web. 28 May 2012. .





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