Mi Ji Lee1, Soo-Jin Cho2, Jeong Wook Park3, Min Kyung Chu4, Heui-Soo Moon5, Pil-Wook Chung5, Jae Myun Chung6, Jong-Hee Sohn7, Byung-Kun Kim8, Byung-Su Kim9, Soo-Kyoung Kim10, Tae-Jin Song11, Yun-Ju Choi12, Kwang-Yeol Park13, Kyungmi Oh14, Jin-Young Ahn15, Kwang-Soo Lee16, Soohyun Cho1, Chin-Sang Chung1. 1. 1 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2. 2 Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea. 3. 3 Department of Neurology, Uijeongbu St. Mary's Hospital, Catholic University of Korea College of Medicine, Uijeongbu, Korea. 4. 4 Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 5. 5 Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. 6. 6 Department of Neurology, Inje University College of Medicine, Seoul, Korea. 7. 7 Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea. 8. 8 Department of Neurology, Eulji Hospital, Seoul, Korea. 9. 9 Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea. 10. 10 Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea. 11. 11 Department of Neurology, Ewha Womans University College of Medicine, Seoul, Korea. 12. 12 Department of Neurology, Presbyterian Medical Center, Jeonju, Korea. 13. 13 Department of Neurology, Chung-Ang University Hospital, Seoul, Korea. 14. 14 Department of Neurology, Korea University College of Medicine, Seoul, Korea. 15. 15 Department of Neurology, Seoul Medical Center, Seoul, Korea. 16. 16 Department of Neurology, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Korea.
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.
OBJECTIVE: To investigate suicidality related to cluster headache and factors associated with increased suicidality in cluster headachepatients. METHODS: In this multicenter study, 193 cluster headachepatients 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 headachepatients 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 headachepatients.
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