The relationship between migraine and suicidal ideation (self-reported thoughts of suicide-related behaviors) in a sample of young adolescents was determined in a study at Taipei Veterans General Hospital, Taipei, Taiwan. Students in three middle schools completed a validated headache questionnaire, the Adolescent Depression Inventory (ADI), and the Pediatric Migraine Disability Assessment questionnaire. The questionnaires assessed the headache profile during the past 3 months and symptoms of depression in the past month. “I think about killing myself” was the indicator of self-reported suicidal ideation. Suicidal ideation in the past month was reported in 8.5% of 3,963 adolescents (2040 male and 1923 female; mean age 14.0 +/- 0.9 years) who completed the study. According to the International Classification of Headache Disorders, 928 subjects (23.4%) were diagnosed with migraine; 138 (3.5%) had migraine with aura, 346 (8.7%) migraine without aura, and 444 (11.2%) with probable migraine. The frequency of suicidal ideation was 6.2% in nonmigraine subjects compared to 16.1% in subjects with migraine (p<0.001), and 23.9% in subjects with migraine with aura (p<0.001). Subjects with suicidal ideation had a higher frequency of headache and headache-related disability. After controlling for depression and sociodemographic factors, the association of migraine and suicidal ideation occurred only for migraine with aura (p=0.025) and high frequency headache (>7 days/month; p=0.013), but not for migraine without aura, probable migraine or for migraine disability score. 
COMMENT. One in four young adolescents with migraine with aura and one in four with frequent headaches (>7 days/month) report suicidal ideation. The frequency of suicidal ideation is one in 2.5 for subjects with both risk factors. The association of migraine with aura and suicidal ideation is independent of depression and pain. Alterations of the serotonergic system have been demonstrated in subjects with both migraine with aura and suicide . The current authors have previously shown that adolescents with chronic daily headaches (>15 days/month) are at increased risk of suicide . The influence of prophylactic medications such as antiepileptics and antidepressants was not evaluated in this study, but chronic prophylactic migraine therapy was used infrequently in this age group. The study demonstrates the importance of evaluation for risk factors of suicidal thoughts in young adolescents with migraine with aura.
Chronic pain conditions of various types (migraine, back problems, arthritis, and fibromyalgia) are associated with suicidal ideation and suicidal attempts, and migraine has the strongest link . In this Canadian study, data were derived from a large nationally representative sample, whereas the Taiwan study was limited to schoolchildren between 13 and 15 years, and questionnaires were validated for this population. The subjects were not referred specifically for headache or migraine and the findings were not explained by a recruitment bias.