Headache Disorders & Migraine Blog Carnival: Headache Disorders and Suicide

Our August 2013 theme is:

Headache Disorders and Suicide.

Migraine, Chronic Back Pain Tied to Higher Suicide Risk Dr. Elspeth Cameron Ritchie, a retired Army colonel and psychiatrist living in Washington, D.C., said the study clearly reinforces the anecdotal link between pain and suicide.
"It makes sense that pain is a risk factor for suicide," she said. "Often, suicide has several different things going on, but pain can be the straw that breaks the camel's back in terms of a person's decision not to go on."

What an opportune topic since we are coming up on my suicide survival date. I think about how I got to that point often. How easy it was to make that choice that night. How it could happen again. How I survived. How it didn't seem to matter one way or the other because things really didn't change afterwards. 

Quote by yours truly

So let's for a moment go back prior to my August 2010 suicide attempt. Had this topic some up I would say we are very aware of the high suicide risk with chronic migraines and other chronic headache disorders. We know and hear about loses in the migraine community and I am always aware at that time there must be so many more we are not aware of. And I myself have always understood the weight of chronic pain over time. More specifically I would have said I am very aware of lack of treatment for pain management and of those acute migraines, status migraines and times where the pain tormented me. I would say of course we have such thoughts. Either in the sense of just this passive desire of wishing for the pain to end. This lack of fear of death because it is an end. We seem to just crave an end to the pain, not an end to our life and so we can fantasize about an end to that pain in many ways. These negative sort of fleeting wishes something would happen... like a stroke or coma such that you would have a valid reason for a break from work and get a break from the torment of trying to function in pain. Which seems so dark but really what it expresses is that a) migraines are not really seen as a valid reason to miss work and b) you feel like you must be completely disabled in some way to get a break, and that would be Fine because even a short break from work would diminish the intensity of the pain and there is this desperate need for that. So it is a desperate wish. Less dark, more desperate. And I would have said most of the time there is no plan to commit suicide, no real desire to die per say but there is this desire for the pain to end, an extreme frustration with lack of treatment and sense of hopelessness that comes with the knowledge that people literally expect you to endure like that. I would have said how can we not have such thoughts with such intense pain? And it doesn't help when the pain can make it extremely hard to sleep and so you add in sleep deprivation. So there can be these deep, raw desperate depressive states when the pain is extreme and no way to treat it and expectations to function... which happen over and over. And with these comes often dark thoughts. I would have said I understand how someone gets to that point and that it disgusts me that doctors fail to manage our pain such that we lose even one person to it. I would have said pain is the key factor as a risk to suicide. However, we also can have comorbid depression and that can further complicate the matter.

And when it comes to my attempt all of that was still true. Even though I was very aware my acute pain long lasting migraines, most of the status migraines as well, often came with these depressive episodes and sleep issues and at times suicidal thoughts... and also was aware as long as I got some sleep and got through the pain I could manage my mood again... didn't prevent that suicide attempt from occurring. I know what depression feels like. I had a bout of depression when I was in my late teens dealing with FM chronic pain while living on my own for the first time. I knew I wasn't depressed. I just knew the pain was too much to handle and was hoping for a treatment management to decrease the intensity or frequency that never came... and you cannot handle that kind of pain for very long without getting desperate. It frays the edges very fast. Your coping skills begin to fail. Those thoughts that you used to be able to handle... make more sense, all those negative preconceptions, ideas and beliefs. And then the more suicidal thoughts. Just make more sense. During those extreme migraines, or long lasting ones... of which i had quite a few. Monthly. More than monthly. Really had no way to temper the pain. You have to remember it is partly years of enduring it. Partly the lack of treatment. The lack of the ability to manage the pain is pretty big obviously. Stress factors at work were a massive issues for years and so when that became an issue yet again, at that particularly bad pain moment, that was quite bad. Ultimatums in the workplace do not make someone desperately in pain 'smarten up' and decide 'hey I'm just going to be a perfectly healthy employee'... because we are aware we cannot be what they want, the ultimatum possibly can be the straw that breaks the camels back... which was in my case. Eventually, I suppose it was almost a statistical inevitability that one day I would Not ignore the depressive state and suicidal thoughts, especially given the ultimatum from work... the status migraine, the sleep deprivation... and that particular time all those thoughts just made perfect sense. Why am I suffering like this? What madness is it to expect me to do so? Why would people expect me to do so? Why should I willingly particulate in this insanity like it is Okay to do this to a person? Why would I willingly endure this torment until what... I retire? My god, I thought, how would I ever get to that point and why would I even want to endure another decade like this let alone more? And around and around my thoughts went digging deeper and deeper until I realized I didn't have to. I didn't have to play the game. There was nowhere in the rules that said I had to willingly participate in my own torture with a smile on my face. You do have to understand I had been on more than a few short term leaves because of the migraines... but never extended to long term and so I was well aware people did not consider this to be a problem. So that was not an option. And you must also understand I was in severe pain... day four of a status migraine, day three I had not slept at all and went to work... so I was in some serious pain. I had already tried aborting it in all the ways I knew how. The ER wasn't an option because a) here they don't know how to abort status migraines or don't believe you have one, not sure which it is and b) it was the middle of the night if I went there it would have been five to seven hours from start to finish and I had this ultimatum that I could not miss work... so that would mean no sleep and likely they wouldn't abort it anyway.

And something in me just clicked and crossed that line from thinking about it to doing it. There is something very spontaneous about pain related suicide. You deal with so much pain all the time and... you do it. And you survive every day. And that is frankly amazing. But it never ends and you never have even the hope that it will potentially end or that at the very least if they are not going to treat your pain they could not expect you to have to work as well and make it even worse. But they do. They expect both acute pain tolerance and full functionality. I wasn't wrong to think it was insane. It is insane. I think it is amazing I survived as long as I did to be honest. The only reason i did is likely the same reason other people do... you don't want to hurt Other people. But eventually you think, well they will grieve for some time but they will be better off without me because I am literally a drain on society, even my employer will do a happy jig when I am gone, and then life will go on and I will be painless. So you can survive a very long time on the idea of not hurting others, until one night you rationalize that away. Most of that is bullcrap though. Every life has meaning and touches other lives and has value. And the pain contorts everything. My life has value beyond the pain, in the moments the sun breaks free of the clouds and I can function... maybe that isn't much right now, but it is something. And I have value to other people. Maybe not to society as a whole, maybe not to my employer... but I do to people that love me. But the pain, in those high intensity moments, of which there is a crapload when you are working, that steals so much sleep, it contorts your Life to be All about the pain. I hate its ability to do that. I really do. It steals my little joys that I work so damn hard to create.

I also hate that I crossed that line from thought into action. So elusive it was. Those desperate thoughts were so raw. So much suffering. But... I Knew they were temporary. Yet. And yet. The pain got me and took me under. Swept me away. As it could have any other time. As it has the potential to do any time in the future. I feel like I have lost my confidence in my coping skills... hard won coping skills from coping with chronic pain since I was a teen. But I never crossed that line or knew how easy it would be to do so. And knowing that is not the sort of knowledge you want. You want to believe you would never get to that point... or that it would be difficult. But that isn't true. And I struggle with these bouts of depression in a way I didn't before because I also have this anxiety... this awareness that I fear myself. I fear my ability to cope if I go back to work... and it is a valid fear. The fact it is valid doesn't change anything... perhaps makes it that much more terrifying.

So I understand how pain alone is a risk factor to suicide with migraines. Pain management for me has never been a priority or, well, there. Sometimes I have a rescue med... mostly not. So it is an issue. That is a lot of pain. Again the madness of expecting someone to function with that much pain is ludicrous. The two are contradictory. That with migraines we also have mood issues with the migraines themselves, those depressive states I mentioned... adding in chronic pain and sleep disorders and we have some serious serotonin issues that do not help. Add in comorbid depression or other mood disorders and it is even more complex. Yet, a problem that isn't talked about enough. The lost lives to this disease seem to outnumber those lost by stroke and heart attacks... yet no one seems to mention this. My own doctor very underwhelmed by my suicide attempt... didn't change my treatment or manage my pain or put me on long term leave from work. It caused me a great deal of distress his disinterest and for a bit true hopelessness. This statistic isn't a big deal to doctors and neuros... but clearly the lack of proper treatment of our pain is a serious issue. I understand how desperate people get. How hopeless. I have been there. Still am there at times. I have triptans to manage daily migraines, and obviously that can't do it. I have T3s as a rescue that I can't even really take because they do cause rebounds. And I am on a long term leave now, likely due to my issues with depression related to pain (migraines are not sufficient remember) and I have no clue what my future will look like in regards to employment or financial stability. I suffer less because I am not working, but I have issues with mood regulation due to anxiety and the unmanaged migraines... I just don't have to force myself to function through them... yet.

People are not alone in these depressive episodes with suicidal ideation but it is a mistake to think it is normal for them to occur with pain, as I did, or that they will just pass when the pain lowers in intensity, as I did. They are dangerous because each one has the potential to sap our strength in that precise moment. Not every suicide is planned. It can be very sudden. And pain can be a massive trigger in addition to external events that may also contribute, such as a work situation. Understand that if these sorts of things are occurring it is a pretty sure sign your pain is Not being managed and that you are having mood regulation issues. The pain not being managed is a problem but that one is hard to solve. The mood regulation issues however I find a psychologist who understands chronic pain to be helpful... since they understand mood, pain and that damned sleep problem which all roll into one big storm. There are many different strategies to use to help with mood regulation, maybe sleep regulation and these sorts of things are pretty vital in helping us cope. I'm still working on them myself but I do know they are pretty damn vital, especially when it comes to suicidal ideation. Doctors may think our pain is meaningless but it isn't. It causes massive problems and we need to everything in our power to help ourselves survive. And to Want to survive. So pain management... outside of doctors, go for it. Try everything a psychologist who helps with chronic pain can come up with... but for certain they will help with mood and perhaps sleep. On the pain side it is worth trying. Also we have to keep after our doctors and neuros to actually help with pain control while they try and help with preventatives... because if our pain is out of control we cannot function, we have no quality of life... and what the hell is that? Just in hell waiting for a glimpse of heaven? I waited and waited for a mildly effective preventative for years and years. That isn't right. And I think we deserve a bit of a life while we work on prevention. And other strategies.

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