Suicide Attempts in US Veterans with Chronic Headache Disorders: A 10-Year Retrospective Cohort Study

• Main Authors: Androulakis XM, Guo S, Zhang J, Sico J, Warren P, Giakas A, Li X, Peterlin BL, Mathew R, Reyes D
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-08-01
• Series: Journal of Pain Research
• Subjects: headache; migraine; suicide attempt; tbi; veteran
• Online Access: https://www.dovepress.com/suicide-attempts-in-us-veterans-with-chronic-headache-disorders-a-10-y-peer-reviewed-fulltext-article-JPR

X Michelle Androulakis,1– 4,* Siyuan Guo,2,* Jiajia Zhang,2 Jason Sico,5,6 Peter Warren,1 Alec Giakas,3 Xiaoming Li,2 B Lee Peterlin,7 Roy Mathew,1,3 Deborah Reyes1 1Department of Neurology, Columbia VA Healthcare System, Columbia, SC, USA; 2Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; 3School of Medicine, University of South Carolina, Columbia, SC, USA; 4Headache Centers of Excellence Program, US Department of Veterans Affairs, Columbia, SC, USA; 5Department of Neurology, Yale School of Medicine, New Haven, CT, USA; 6Headache Centers of Excellence Program, US Department of Veterans Affairs, West Haven, CT, USA; 7Pennsylvania Headache Center, Camp Hill, PA, USA*These authors contributed equally to this workCorrespondence: X Michelle Androulakis Email [e-mail]: A large-scale retrospective analysis of veterans with chronic pain was conducted to examine (1) the annual incidence of suicide attempts (SA) in veterans with chronic headache and other chronic pain conditions, and (2) the risk of SA in men and women with chronic headache and chronic headache concurrent with traumatic brain injury (TBI) as compared to non-headache chronic pain.Methods: This retrospective study (N=3,247,621) analyzed National Veterans Affair Health Administrative data of patients diagnosed with chronic head, neck, back and other chronic pain from 2000 to 2010. Multivariable Poisson regression was used to explore the relative risks of SA in veterans with chronic headache and chronic headache concurrent with TBI as stratified by sex.Results: Veterans with chronic headaches had the highest annual incidence of SA (329 to 491 per 100,000) each year among all identified types of chronic pain conditions. Compared to other non-headache chronic pain, chronic headache is associated with increased risk of SA [men RR (1.48), CI (1.37,1.59); women RR (1.64), CI (1.28,2.09)], after adjusting for demographic factors, TBI, and psychiatric comorbidities. The risk increased further when chronic headache is comorbid with TBI [men RR (2.82), CI (2.60, 3.05); women RR (2.16, CI (1.67– 2.78)].Conclusion: Veterans with chronic headache have a higher risk of SA than those with other chronic pain and women with chronic headache are at a higher risk than men with chronic headache. Chronic headache concurrent with TBI further heightened this risk, especially in men. Our data underscore the importance of identifying specific types of chronic pain in veterans with comorbid TBI and sex disparity associated with SA when targeting suicide prevention measures.Keywords: headache, migraine, suicide attempt, TBI, veteran