Effect of migraine on suicide mortality in young adults: a nationwide cohort study in South Korea

Background Migraine is linked to increased suicidal behaviour, but its relationship with suicide mortality remains underexplored. In South Korea, suicide rates are among the highest in Organisation for Economic Co-operation and Development nations, particularly in young adults. Objective To investigate the effect of migraine on suicide mortality in young Korean adults. Methods Participants who underwent the Korean Health Examination from 2009 to 2012 were enrolled in this study and followed up until 2021. Participants aged 20-39 years (n=6 539 547) were categorised based on their migraine status. Cox proportional hazards regression models assessed the association between migraine and suicide mortality, adjusting for demographic factors, health behaviours and comorbidities. Findings Among 6 539 547 participants, 113 681 (1.74%) had migraine (6620 (0.10%) with aura, 107 061 (1.64%) without aura). Over 11 years, there were 21 suicides (0.32%) in migraine with aura, 219 (0.20%) in migraine without aura and 13 040 (0.20%) in no migraine. All migraine was not linked to increased suicide risk (HR 1.07, 95% CI 0.94 to 1.21), but migraine with aura showed a higher risk (HR 1.61, 95% CI 1.05 to 2.47). Migraine without aura had no increased risk (HR 1.03, 95% CI 0.90 to 1.18). Depression modified the association across migraine subtypes. Conclusion and implications Although all migraine and migraine without aura were not significantly associated with a higher suicide risk compared with that in the absence of migraine, migraine with aura was associated with a higher risk of suicide mortality. Depression significantly modified this relationship, showing different associations across migraine subtypes.