Migraine is classified as a pain-based neurologic condition defined by chronic, recurring headaches that may include symptoms of intense pain, nausea, vomiting, environmental hypersensitivity, and aura. Youth who suffer from migraines are at a greater risk for emotional distress, and psychiatric comorbidities, and both suicidal ideation and attempts. 

Chronic Migraines in Children and Adolescence

Being that depression is one of the most important risk factors for suicide, and depression rates are higher in chronic pain patients and adolescents, understanding the link between pain and suicide is critical. Chronic pain in children and adolescents is linked with peer rejection, peer victimization, and isolation which are all significant factors for suicide and depression. 

University of Illinois at Chicago

Research suggests that the presence of a chronic medical illness is a risk factor for suicidality and completed suicide in youth. 

Suicide and Suicidality in Children and Adolescents with Chronic Illness

Iannucci, J., & Nierenberg, B. (2022). Suicide and suicidality in children and adolescents with chronic illness: A systematic review. Aggression and Violent Behavior, 64, 101581.

Iannucci & Nierenberg (2022)

The early phase of development when children and adolescents face normative challenges (e.g., identity development, development of emotional, physical, and behavioral autonomy) is also a pivotal time in respect to health and illness. Children and adolescents who are born with or develop a chronic illness in these early phases of life are presented with an additional set of challenges. 

Chronic Illness and Child and Adolescent Health Development

Bronchial asthma, respiratory, allergic diseases, and cystic fibrosis are all disorders that are common in children and may develop throughout the lifespan. The psychological burdens of asthma and CF, namely the increased risks of depression, anxiety, suicidal behaviors, and substance abuse have been documented in multiple countries in epidemiological and population-based studies, as well as smaller cohort-specific studies.

Child and Adolescent Respiratory Diseases 

The specific brain abnormalities seen in epilepsy may explain the relationship of epilepsy, suicidality, and the high occurrence of disruptive (ADHD, oppositional defiant disorder, and conduct disorder) and emotional psychiatric disorders. Compared to healthy youth, children with epilepsy have decreased orbital-frontal volumes, as these abnormalities in this region of the brain are associated with the emotional dysregulation that leads to suicide behaviors, depression, and impulsivity. 

Epilepsy in Children and Adolescence 

In youth with diabetes, depression in particular may take a more severe course, as such a comorbidity has been associated with a ten-fold increase in both suicide, and suicidal ideation. Also, noncompliance with medial regimens in cases of repeated episodes (e.g., taking insulin appropriately) is not rare in youth with type 1 diabetes. This can be seen as intentional and a form of self-harm. 

Diabetes Mellitus in Children and Adolescence 

Researchers often look to depressive symptomatology to explain the presence of suicidal thoughts and/or behaviors. Although depression is less common in youth with epilepsy but highly prevalent in youth with diabetes and youth who experience migraine with aura, these three illness cohorts typically see more severe presentations of depression.

Role of Depression 

Risks for suicidal ideation, suicide attempts, and death by suicide were primarily identified as late psychological effects of pediatric cancer diagnosis and treatments. Age of diagnosis was identified as a risk factor such that those diagnosed under the age of four were at greater risk for severe mental health events and suicide attempts, and those diagnosed under the age of 14 were at greater risk for death by suicide.

Childhood Cancer 

With evidence consistently showing health declines for individuals with chronic illness during the transition from pediatric to young adult health services, which may precipitate suicidal thoughts and behavior, it would be important to determine if assessing for suicidal risk in addition to in-clinic sessions that aim to identify psychiatric disorder results in reduced suicide and suicidality. Also, partnerships with community-based agencies can be established to provide access to support groups that promote healthy behaviors and social participation. 

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