Having migraines and fibromyalgia increases the risk of suicide

About 12% of the population suffers from migraines. In addition to high rates of migraine-related disability, migraineurs are at a higher risk than the general population of additional disability related to depression, anxiety, irritable bowel syndrome, fibromyalgia, and other conditions.

Fibromyalgia is a disorder of the central nervous system with increased brain excitability. It often manifests itself not only with muscle pains, but also fatigue, memory problems, and sleep and mood disturbances. Various studies estimate that anywhere from 2% to 8% of the general adult population suffers from fibromyalgia. Just like with migraine, women are more often affected than men. The likelihood of coexisting fibromyalgia increases with increasing frequency and severity of migraine attacks.

Both migraine and fibromyalgia have been individually linked with increased risk of suicide. However, it is not clear that the risk is more than additive.

A study just published in Neurology, reports that patients with migraine and coexisting fibromyalgia have a higher risk of suicidal ideation and suicide attempts compared with migraine patients without fibromyalgia.

The study looked at 1,318 patients who attended a headache clinic. Of these patients, 133 or 10% were found to also have fibromyalgia. Patients with both conditions had more frequent, more severe, and longer-lasting migraine attacks as well as higher use of abortive medications.

Compared with migraine patients who did not have fibromyalgia, those with fibromyalgia were more likely to report suicidal ideation (58% vs 24%) and suicide attempts (18% vs 6%).

This report suggests that migraine and fibromyalgia may magnify the risk of suicide compared with the risk of the individual conditions. However, because this data comes from a specialty headache clinic, many patients were severely affected by their migraines, with more than 35% having chronic migraine. It is likely that the results would be less dramatic among migraine sufferers in the general population. Almost half of the estimated 35 million migraine sufferers in the US do not consult a physician. Most of them suffer from milder migraines than those who do consult a doctor.

This study suggests that patients with migraine should be evaluated for other chronic pain conditions and for their mental health well-being. In particular, patients with chronic migraine should be screened for other painful conditions and mental illness. And patients with fibromyalgia should also be evaluated for migraine and potential suicide ideation. Patients often do not appear depressed, but simple questions can detect depression, which can lead to effective treatment. Our initial evaluation at the New York Headache Center includes two questions which are highly indicative of depression: 1. Have you been bothered a lot in the last month by feeling sad, down, or depressed? 2. Have you been bothered a lot in the last month by a loss of interest or pleasure in your daily activities?

Antidepressants have been proven to be effective for the prevention of migraines even in the absence of depression and are the best choice for people suffering from both conditions. Prozac, Lexapro and other SSRI antidepressants do not help migraines or pain, but SNRIs such as Effexor, Cymbalta, and Savella or tricyclics such as Elavil, Pamelor, and Vivactil do relieve pain and depression.

Magnesium deficiency is common in both migraines and fibromyalgia and we recommend an oral supplement to all patients. Some patients do not absorb magnesium and respond very well to monthly intravenous infusions of magnesium. Both their migraines improve as do fibromyalgia symptoms.

One interesting difference between migraines and fibromyalgia is the response to Botox. Botox is proven to be highly effective for the prevention of migraines and it works very well to relax spastic muscles. However, Botox appears to be ineffective for the treatment of muscle spasm in fibromyalgia. It is possibly explained by the fact that Botox interferes with the function of acetylcholine, a neurotransmitter involved in contracting healthy muscles. In fibromyalgia, studies suggests a deficit in acetylcholine, so further blocking it would be ineffective or even make the muscle pain worse (which I’ve seen in a few patients).

  1. Kelsey says: 01/05/20163:08 pm

    Thank you for your response and time. You’re right- I need to be asking my doctor these questions. I am not crazy about taking fioricet because of those reasons and would like to continue maxalt. I understand serotonin syndrome is very rare but when I took maxalt with citalopram (not maxalt alone-I’m fine with that) I was shaking, increased heart rate, agitated and vomiting. So I went to the ER and the doctor there, which I assumed wasn’t a neurologist, diagnosed too much serotonin. I had only been on citalopram for a few weeks and I took 10mg of maxalt. Are you saying I could try taking a 5mg in my doctors office while on lexapro? Thank you.

  2. Dr. Mauskop says: 01/05/20169:28 am

    These questions are better addressed to your doctor, but as a general rule, Maxalt is out of your system completely in about 6 hours. You have to be careful with Fioricet because it contains caffeine, which can cause rebound headaches. It also contains butalbital, a potentially addictive substance. Serotonin syndrome is extremely rare from triptans, such as Maxalt and you may want to ask your doctor about trying 1/2 tablet in his office.

  3. Kelsey says: 01/05/20163:11 am

    Also I’m sorry to bother you with my above question. I asked my doctor and pharmacist and they only seemed sure on its half life but didn’t seem to know how long until maxalt is completely eliminated. You are very knowledgable about triptans and I have been unable to find a good neurologist in the area I live. Thank you very much for your blog and sharing so much in depth information on migraines. I have been helped immensely by the information you’ve shared, so thank you!

  4. Kelsey says: 01/05/20161:45 am

    My doctor is recommending I take lexapro for depression and gave me fioricet for migraines instead of maxalt. He told me not to take maxalt with lexapro because of my history with serotonin syndrome. My question is: how long do I have to wait after taking maxalt before I can start the lexapro? I can only find information online regarding maxalt said half life. How long until it’s fully out of my body so I don’t risk too much serotonin? Thank you!

  5. Dr. Mauskop says: 11/17/20155:05 pm

    You may want to ask your doctor about trying non-serotonin antidepressant, such as bupropion (Wellbutrin). Another option is to try preventive treatments for your migraines, such as Botox, magnesium and other supplements, and preventive medications.

  6. Kelsey says: 11/17/201511:53 am

    What would you recommend if I have depression and migraine but can’t take an SSRI or SNRI because I developed serotonin syndrome from taking citalopram with maxalt? My doctor thinks I need to be on an antidepressant and told me to just take Advil and not maxalt during an attack.. I’m too afraid to not be able to rely on maxalt because Advil rarely helps me. So m stuck feeling like I have to either treat my depression and suffer with incapacitating migraines or treat my migraines and suffer from depression. Please help. Thank you so much.

  7. Dr. Mauskop says: 11/05/20152:15 pm

    Yes, any treatment that helps migraines such as exercise, magnesium, drugs, Botox, etc, can help the letdown headaches as well.

  8. Kelsey says: 11/05/20152:04 pm

    I mentioned let down migraines in my other question. Are let down migraines helped by antidepressants that you mentioned above or do you have another post/advice on this? Thank you.

  9. Dr. Mauskop says: 10/30/201512:49 pm

    I would try to find a doctor who could give magnesium intravenously, or at least check your RBC magnesium level (not serum level, which is unreliable). Botox injections is another treatment that works better than drugs and without drugs’ side effects.

  10. Scharee says: 10/30/20155:58 am

    I have had daily chronic headache for 11 years and its not just my head that hurts my body hurts too neck shoulders arms legs back and I am very sensitive to touch I no longer take any kind of medication accept motrin for pain. All other medications seem to make my symptoms worse. Every doctor I have seen has said to me all I can do for you is give you meds. I try taking magnesium but the upset to my stomach is intense. I have gained at least 120 pounds since this started and I was already severely over weight but mobile and active because all I want to do is rest and stay in dark room. I found that stretching helps my neck to be more mobile but if I stop like I did recently to take care of my dad the pain comes back. It just seems hopeless no social life no real life at all because all I feel is pain all the time.

  11. Dr. Mauskop says: 10/05/20159:42 pm

    Actually, having almost any painful condition makes a person more likely to develop another. This is probably because chronic pain makes the brain more excitable and more prone to perceiving pain.
    Besides taking a magnesium supplement, there are several drugs which can help both migraines and fibromyalgia. These include gabapentin (Neurontin), pregabalin (LYrica), amitriptyline (Elavil), and other. Other proactive steps include Botox injections for chronic migraines, meditation, aerobic exercise, getting enough sleep, and a healthy diet.

  12. Ellen says: 10/05/20158:59 pm

    Thanks for this informative post on migraine and fibromyalgia. I have read very little about the intersection between these two conditions. My mother (age 72) was diagnosed with fibromyalgia many years ago and only recently did she realize that her frequent “sinus headaches” are actually migraine headaches. She takes Cymbalta but doesn’t think it helps much with either condition. I was diagnosed with chronic migraine in 2011 and am concerned about also developing fibromyalgia, based on the suffering I’ve observed in my mother. Both conditions seem intractable, which is very frightening. Are there any proactive actions that migraine patients can take to decrease the chance of developing fibromyalgia? It seems that very little is known about the cause of the disease.

Submit comment