Elevated Suicide Risk Identified in People with Headache Disorders

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Individuals diagnosed with headache disorders had a greater risk for attempting and completing suicide, according to results of a cohort study published in JAMA Neurology.¹

“Our results further suggest a strong and persistent association with attempted and completed suicide across headache disorders including [tension-type headache]—a highly prevalent primary headache disorder typified by its mild to moderate intensity—suggesting that even patients with milder headaches may experience elevated suicide risk,” wrote investigators, led by Holly Elser, MD, from the department of clinical epidemiology at Aarhus University and Aarhus University Hospital, in Denmark.¹

This is not the first study to suggest a link between migraine and attempted suicide, but limited research exists on the risk of attempted and completed suicide across headache disorders.² Elser and colleagues sought to examine the association between attempted and completed suicide with headache disorders, such as migraine, tension-type headache, posttraumatic headache, and trigeminal autonomic cephalalgia (TAC).¹

From May 2023 to May 2024, the team conducted a population-based cohort study of Danish citizens. Among the 5.6 million population of Denmark between 1995 to 2020, the study included 119 486 people aged ≥ 15 years (69.5% women) with a headache diagnosis. Those with a headache diagnosis were matched 5:1 by sex and birth to people without a headache diagnosis (n = 597 430; 69.5% women). The sample ranged from 29.1 to 51.6 years old, with a mean age of 40.1 years.¹

Among the headache disorders, 75 403 people were diagnosed with migraine, 48 482 with tension-type headache, 5730 with posttraumatic headache, and 6872 with TAC. The mean follow-up time was 8.6 and 8.9 for people diagnosed with a headache disorder and those without, respectively.¹

Investigators observed the headache group was more likely to be treated with antidepressants or opioids, with more prevalent medical and psychiatric comorbidities. The headache group had 603 attempted suicides (0.5%) and 156 completed suicides (0.1%).¹

People diagnosed with headaches had an increased risk of attempted and completed suicide throughout the study. For instance, the 15-year risk of attempted suicide for people with a headache diagnosis was 0.78% (95% CI, 0.72% - 0.85%), compared with 0.33% (95% CI, 0.31 – 0.35) for individuals without a headache. The 15-year risk of completed suicide was 0.21% (95% CI, 0.17% - 0.24%) for people diagnosed with headache, compared with 0.15% (95% CI, 0.13% - 0.16%) for people without a headache.¹

Additionally, the analysis showed individuals diagnosed with headache disorders had an increased risk of attempted and completed suicide at 5 years (0.19%; 95% CI, 0.15 – 0.22%; 0.04; 95% CI, 0.02% - 0.06%) and 10 years (0.33%; 95% CI, 0.28 – 0.38%; 0.05; 95% CI, 0.03 – 0.08%), respectively.¹

As for hazard ratios (HR), investigators saw increased risks for attempted suicide (HR, 2.04; 95% CI, 1.84 – 2.27) among people diagnosed with headaches compared with controls. This was observed for all headache types: migraine (HR, 1.71; 95% CI, 1.50 – 1.95), tension-type headache (HR, 1.91; 95% CI, 1.63 – 2.24), posttraumatic headache (HR, 3.14; 95% CI, 1.81 – 5.47), and TAC (HR, 1.97; 95% CI, 1.35 – 2.87). Investigators also saw increased risks for completed suicide (HR, 1.40; 95% CI, 1.17 – 1.68) among people diagnosed with headache of all types: migraine (HR, 1.09; 95% CI, 0.84 – 1.42), tension-type headache (HR, 1.44; 95% CI, 1.09 – 1.91), posttraumatic headache (HR, 3.22; 95% CI, 1.40 – 7.40), and TAC (HR, 2.40; 95% CI, 1.23 – 4.66).¹

The sex-stratified and age-stratified analyses observed similar associations between headache and both attempted and completed suicide. Researchers noted that the association between headache and suicide was stronger for people who were first diagnosed in the inpatient or emergency department setting for attempted suicide. Treatment with antidepressants attenuated the higher risk for attempted suicide but not completed suicide, added Elser and colleagues.¹

“As headache disorders are highly prevalent at the population level, early diagnosis and effective treatment of headache could potentially help to reduce the risk of attempted and completed suicide,” investigators concluded.¹ “Findings from the present study further suggest that early evaluation and focused behavioral health interventions may be particularly important for persons diagnosed with headache.”

References:

1. Elser H, Farkas DK, Fuglsang CH, Sørensen ST, Sørensen HT. Risk of Attempted and Completed Suicide in Persons Diagnosed With Headache. JAMA Neurol. 2025 Feb 3:e244974. doi: 10.1001/jamaneurol.2024.4974. Epub ahead of print. PMID: 39899309; PMCID: PMC11791769.
2. Giakas A, Mangold K, Androulakis A, Hyduke N, Galynker I, Thiam M, Cai G, Androulakis XM. Risks of suicide in migraine, non-migraine headache, back, and neck pain: a systematic review and meta-analysis. Front Neurol. 2023 Apr 20;14:1160204. doi: 10.3389/fneur.2023.1160204. PMID: 37153662; PMCID: PMC10157105.