Headache Diagnosis Associated With Risk for Suicide Attempt, Completion

Content warning: This article mentions suicide.

Rates of suicide attempt and completion are higher among individuals diagnosed with headache than the general population, according study findings published in JAMA Neurology.

The relationship between headache and suicidality is understudied, however, a study from the United States reported that more than half of individuals with cluster headache had suicidal thoughts (55%) and 2% had attempted suicide.

Researchers from Aarhus University and Aarhus University Hospital sourced data for this study from the Danish National Healthcare System. Individuals aged 15 years and older (n=119,486; female, 69.5%) diagnosed with migraine (n=75,403), tension-type headache (TTH; n=48,482), trigeminal autonomic cephalalgia (TAC; n=6872), and posttraumatic headache disorder (n=5730) between 1995 and 2020 were included in this study. Individuals from each headache group were matched with 5 individuals (n=597,430; female, 69.5%) from the general population not diagnosed with headache. The mean age of participants was 40.1 years. The outcome of interest was the rate of attempted and completed suicide.

Among individuals with headache and control individuals:

• 21.2% and 7.3% used antidepressants,
• 21.9% and 7.1% used opioids,
• 19.0% and 16.4% had completed basic education, and
• 27.8% and 24.1% had a household income in the first quartile, respectively.

A total of 603 suicide attempts and 156 completions occurred during follow-up among individuals diagnosed with headache.

Patients with headache had higher 15-year risk for suicide attempt (absolute risk [AR], 0.78% vs 0.33%) and completion (AR, 0.21% vs 0.15%) compared with the general population, respectively.

Headache associated with higher risk for suicide attempt at 5 (risk difference [RD], 0.19%; 95% CI, 0.15%-0.22%), 10 (RD, 0.33%; 95% CI, 0.28%-0.38%), and 15 (RD, 0.45%; 95% CI, 0.39%-0.53%) years and for suicide completion at 5 (RD, 0.04%; 95% CI, 0.02%-0.06%), 10 (RD, 0.05%; 95% CI, 0.03%-0.08%), and 15 (RD, 0.06%; 95% CI, 0.02%-0.10%) years.

Stratified by headache diagnosis, risk for suicide attempt was greatest with posttraumatic headache (adjusted hazard ratio [aHR], 3.14; 95% CI, 1.81-5.47), followed by TAC (aHR, 1.97; 95% CI, 1.35-2.87), TTH (aHR, 1.91; 95% CI, 1.63-2.24), and migraine (aHR, 1.71; 95% CI, 1.50-1.95) relative to control individuals. Similarly, suicide completion was associated with posttraumatic headache (aHR, 3.22; 95% CI, 1.40-7.40), TAC (aHR, 2.40; 95% CI, 1.23-4.66), and TTH (aHR, 1.44; 95% CI, 1.09-1.91).

Stratified by gender, headache increased risk for suicide attempt more among men (aHR, 2.14; 95% CI, 1.76-2.62) than women (aHR, 2.00; 95% CI, 1.76-2.26) and suicide completion more among women (aHR, 1.52; 95%CI, 1.13-2.06) than men (aHR, 1.32; 95% CI, 1.05-1.67).

This study may have been limited by the lack of diversity in the study population.

“[H]eadache diagnoses were robustly associated with increased risk of attempted and completed suicide after accounting for sociodemographic factors and baseline medical and psychiatric comorbidities. 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,” the researchers concluded.

If you or someone you know is struggling or in crisis, help is available. Please call, text, or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.