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Aggression Common in Chronic Migraine, May Help Identify Suicidality in Patients With Migraine

Alison Rodriguez

A recent study, published by The Journal of Headache and Pain, investigated aggression and its association with suicidality in migraine patients, finding that aggression is likely to be a common feature of chronic migraine. Study findings also concluded that comorbid aggression may help to identify suicidality in migraine patients.

“Aggression occurs in relation to physical pain,” the authors explained. “In the General Aggression Model, physical pain as a situational factor influences cognitions, feelings, and arousal, which in turn affects appraisal and decision processes, which in turn influence aggressive or nonaggressive behavioral outcomes. Migraine patients suffer from recurrent severe headache as physical pain.”

The study included 144 migraine patients who had visited a headache clinic for the first time between January 2017 and September 2017. The researchers collected data on patients’ clinical characteristics and data from patient-completed questionnaires, such as the Aggression Questionnaire (AQ). Furthermore, the study conducted interviews with patients, using the Mini International Neuropsychiatric Interview—Plus Version 5.0.0 (MINI) in order to identify suicidality.
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Using the data, the researchers compared the degree of aggression in migraine patients to the degree of aggression in healthy controls. Major determinants for aggression and its association with suicidality were also evaluated.

“Migraine has been known to be associated with depression, anxiety, and suicidality,” stated the authors. “Therefore, it is also important to acknowledge aggression in relation to suicidality in migraine patients because lethal suicidal attempts are associated with mortality.”

The results revealed that the overall AQ score and anger and hostility subscale scores were higher in migraine patients than in controls. Patients with chronic migraine had an overall higher AQ score and physical aggression, anger, and hostility subscale scores than the controls.  However, AQ scores in patients with episodic migraine were not different from the controls’ scores.

The major determinants of the overall AQ score were anxiety, headache intensity, and chronic migraine. Additionally, patients who had suicidality based on the MINI showed a higher overall AQ score than those without suicidality, according to the results.

“We found the overall AQ score was higher in patients with suicidality than those without suicidality. That means aggression may reflect suicidal ideation or attempt in migraine patients,” stated the authors. “Therefore, asking about aggressive feelings or behaviors in migraine patients will be another option for identifying suicidality, especially if clinicians feel uncomfortable asking them about suicidal ideation or attempts directly.”

The researchers noted that these results emphasize the need for recognition and proper management of aggression, which will be helpful in reducing mortality in chronic migraine patients.

Reference:
Park S, Seo J. Aggression and its associatoin with suicidality in migraine patients: a case-control study [Published online August 14, 2018]. J Headache Pain. doi: https://doi.org/10.1186/s10194-018-0903-x.
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