Headaches and Suicide
The risk of a suicide attempt was 2 times greater among those with headache, across types including tension type headache, migraine, trigeminal autonomic cephalalgia, and posttraumatic headache.
Persons with first-time headache diagnosis identified from inpatient hospitalizations, emergency department visits, outpatient specialty clinics and followed for attempted or completed suicide.
Among those with headache 603 attempted suicides (0.5%) and 156 completed suicides (0.1%)
The risk of attempted suicide was more than 2 times higher among those with headaches vs those without across the headache types included. The greatest risk for a suicide attempt was among those with posttraumatic headache, at hazard ratio of 3.14.
The risk of completed suicide was 40% higher among those with vs without headaches across the headaches studied. The greatest risk for a completed suicide was among those with posttraumatic headache, at hazard ratio of 3.22.
The authors reported that those with headaches who were more likely to attempt or complete suicide also were more likely to have comorbid medical and psychiatric disorders and to be receiving concomitant treatment with antidepressants, opioids.
The authors confirm a strong and persistent association with attempted and completed suicide across headache disorders. However, the inclusion of TTH among the types is new – a highly prevalent primary headache typically considered mild that may have been overlooked in the past.
The authors recommend that all individuals with headaches, regardless of type, should be evaluated for depression, suicidal ideation and monitored over time. They also note that the greater risk of suicide attempts among those on antidepressants may reflect the drugs' frequent prescription for headaches (migraine, TTH) but at doses subtherapeutic for depression.
Study limitations: The population studied may have had more severe or more difficult to manage headaches, and so have been more prone to suicidal thoughts and behaviors. Future studies should examine this.
Studies have indicated that migraine and cluster headaches appear to be associated with increased risk for attempted and completed suicides. A new study sought to determine if this apparent association also holds true for other common headache conditions. The population-based study utilized several Danish patient registries which provided data on hospitalizations, emergency department visits, outpatient specialist visits, diagnoses, and suicide attempts and completed suicides. The headache diagnoses examined were:
- Migraine
- Tension type headache (TTH)
- Trigeminal autonomic cephalalgia (TAC) (includes cluster headache)
- Posttraumatic headache disorder (PTT)
