The link between headache disorders and suicide—a 25-year Danish cohort study

New evidence from a large population-based cohort analysis indicates an increased risk of both attempted and completed suicide among individuals diagnosed with headache disorders. Researchers at Aarhus University in Denmark found that individuals diagnosed with migraine, tension-type headache, posttraumatic headache, and trigeminal autonomic cephalalgia face an increased risk of suicide.

Headaches affect approximately 66.6% of people worldwide and often co-occur with psychiatric comorbidities. Previous research has linked migraine with higher rates of suicidal thoughts and behavior, but data on this association across all headache types is limited. This gap suggests a need for further exploration of suicidality among patients with headache disorders.

In the study “Risk of Attempted and Completed Suicide in Persons Diagnosed With Headache,” published in JAMA Neurology, Danish citizens aged 15 years or older with first-time headache diagnoses from 1995 to 2020 were matched 5-to-1 with individuals without a recorded headache diagnosis.

The cohort included 119,486 individuals diagnosed with headaches and 597,430 matched controls without a headache diagnosis. Diagnostic codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, captured migraine, tension-type headache, posttraumatic headache, and trigeminal autonomic cephalalgias.

Individuals diagnosed with headaches had a 15-year absolute risk of 0.78% for attempted suicide compared with 0.33% in the matched control group, yielding a risk difference of 0.45%.

Completed suicide reached a 15-year absolute risk of 0.21% compared with 0.15% in controls, yielding a 0.06% risk difference. Adjusted hazard ratios remained significantly higher at 2.04 for attempts and 1.40 for deaths in those diagnosed with a headache disorder, with stronger associations seen in posttraumatic headache and trigeminal autonomic cephalalgias (TACs).

Migraine showed an adjusted hazard ratio (HR) of 1.71 for attempted suicide and 1.09 for completed suicide.

Tension-type headaches had an HR of 1.91 for attempted suicide and 1.44 for completed suicide.

Posttraumatic headache was associated with an HR of 3.14 for attempted suicide and 3.22 for completed suicide.

TACs registered an adjusted HR of 1.97 for attempted suicide and 2.40 for completed suicide.

People diagnosed with headaches showed higher rates of co-occurring medical and psychiatric conditions, including cancer, cardiovascular disease, chronic obstructive pulmonary disease, stroke, head injury, mood disorders, substance use disorders, and others.

Controlling for these baseline diagnoses still found a persistent association between headaches and increased suicide risk. Among individuals who had mood or substance use disorders, that association was smaller but remained present. The increased risk persisted regardless of sex, age, income, or educational background.

Findings from the study suggest that early evaluation and focused behavioral health interventions may be particularly important for persons diagnosed with headaches.

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