Increased suicidality in patients with cluster headache

Abstract

Objective To investigate suicidality related to cluster headache and factors associated with increased suicidality in cluster headache patients. Methods In this multicenter study, 193 cluster headache patients were recruited between September 2016 and August 2018. Patients were asked about their suicidality during and between attacks, specifically about passive suicidal ideation, active suicidal ideation, suicide plan, and suicide attempt. Univariable and multivariable logistic regression analyses were performed to evaluate the factors associated with high ictal suicidality (sum of positive response ≥ 2). Patients were followed up when they were in the between-bouts period. Results A total of 175 cluster headache patients in the in-bout period were included in this study. Passive suicidal ideation, active suicidal ideation, suicidal planning, and suicidal attempt were reported by 111 (64.2%), 62 (35.8%), 10 (5.8%), and four (2.3%) patients during attacks; seven (4.0%), six (3.5%), five (2.9%) and two (1.2%) patients interictally; and none (0%), one (1.9%), one (1.9%), and none (0%) among patients in the between-bouts period. Factors associated with high ictal suicidality were longer disease duration, the Headache Impact Test score, and the Patient Health Question-9 score (multivariable OR = 1.90 per 10-year increase in disease duration, 95% CI = 1.18–3.05, p = 0.008; multivariable OR = 3.19 per 10-point increase in HIT-6, 95% CI = 1.73–5.87, p < 0.001; multivariable OR = 2.11 per 10-point increase in PHQ-9, 95% CI = 1.13–3.95, p = 0.020, respectively). Conclusions Cluster headache attack carries a high suicidality compared to the interictal or between-bouts state. An intensive treatment to reduce cluster headache burden may be helpful to alleviate suicide risk in cluster headache patients.

Exploring the Connection Between Sleep and Cluster Headache: A Narrative Review

“…Cluster headache is characterized by a paroxysmal onset of severe unilateral typically periorbital pain that often peaks in intensity in a matter of moments; pain can be so severe that the disorder has been nicknamed the “suicide headache” [ 13 , 14 ]. Attacks are described as bouts, each lasting about 15 min to 3 h, then resolving spontaneously, only to repeat the cycle again over a period of hours or days, i.e., “clusters”.…”

The first-line cluster headache medication verapamil alters the circadian period and elicits sex-specific sleep changes in mice

“…Cluster headache (CH) is a headache disorder widely regarded as one of the most painful human experiences (Burish et al 2020) with a high rate of suicidal thoughts and attempts (Ji Lee et al 2019;Rozen and Fishman 2012;Trejo-Gabriel-Galan et al 2018). The diagnosis of cluster headache is made by defining criteria: 1-8 headache attacks per day of one side of the face, with each attack lasting between 15 min and 3 h, associated with restlessness and/or cranial autonomic features, such as a bloodshot eye and nasal congestion on the same side as the pain (Headache Classification Committee of the International Headache Society (IHS) 2018).…”

Cluster headache is one of the most intensely painful human conditions: Results from the International Cluster Headache Questionnaire

“…Hopelessness is considered a core component of suicidality, 27,28 and our data suggest hopelessness is higher when pain is maximal. Additionally, a previous study in cluster headache found an association between higher attack intensity and suicidal behavior 6 . Additional studies are needed to investigate whether hopelessness and pain intensity are dependent or independent risk factors for suicide in cluster headache.…”