March 2025
Headache disorder may be linked with suicide risk
By Rebecca Jenkins
Patients with headache disorder have a higher suicide risk, a large population-based cohort study finds, with the association extending across several headache types.
Previous studies had found increased rates of suicidal thoughts and behaviour in people with headache disorders, but much of the literature had focused on migraine and cluster headache, researchers wrote in JAMA Neurology.
In the Danish population-based cohort study, almost 200,000 people aged 15 years and older who were diagnosed with migraine, tension-type headache, post-traumatic headache and trigeminal autonomic cephalalgia (TAC) such as cluster headache were matched by sex and birth year to almost 600,000 people without a headache diagnosis.
Researchers identified first-time headache diagnoses from inpatient hospitalisations, emergency department visits and outpatient specialty clinic visits and identified attempted and completed suicides from patient and death registries.
Comparing 119,486 people diagnosed with headache with 597,430 matched controls over 15 years’ follow up, the researchers found a hazard ratio (HR) of 2.04 for attempted suicide and 1.40 for completed suicide among people with headache compared with the comparison cohort.
The findings were consistent across headache types, but there were stronger associations for TACs and post-traumatic headache, they noted.
‘Results of this cohort study revealing the robust and persistent association of headache diagnoses with attempted and completed suicide suggest that behavioural health evaluation and treatment may be important for these patients,’ the researchers concluded.
Dr Faraidoon Haghdoost, a Research Fellow in headache disorders at The George Institute for Global Health, and Conjoint Lecturer at UNSW Sydney, said the study findings were particularly relevant given the growing awareness of the link between headache disorders and mental health.
‘Importantly, it highlights that this risk is not limited to specific headache types like cluster headache, which has been previously recognised for its association with suicidality, but extends across different headache disorders,’ he told Medicine Today.
The study population could be skewed towards individuals with more severe headache disorders, Dr Haghdoost noted, as the diagnoses were made in inpatient hospitalisations, emergency department visits and specialty outpatient clinic visits.
‘As a result, this study may not fully capture the suicide risk in individuals with less severe forms of migraine or tension-type headache,’ he said.
The findings underscored the need for clinicians to be vigilant in assessing mental health in all headache patients.
Dr Haghdoost recommended that clinicians routinely screen for depression and suicidal ideation, especially in patients with severe or chronic headache disorders.
‘Effective headache management should go hand in hand with addressing psychiatric comorbidities, as treating one without the other may not fully mitigate suicide risk.’
Future research should explore whether specific headache features, such as chronic versus episodic, high-pain severity or frequency of attacks, were associated with a higher risk of suicidality.