Headache associated with attempted, completed suicide

Key takeaways:

• The study matched more than 114,000 Danish citizens diagnosed with headache to those without.
• Those without headache had lower rates of attempted and completed suicide.

DENVER — Among a large cohort of Danish citizens, headache disorders were strongly associated with attempted and completed suicide, according to a presenter at the American Academy of Neurology annual meeting.

“There is evidence suggesting that headache disorders often co-occur with psychiatric illnesses,” Holly C. Elser, MD, MPH, PhD, an epidemiologist and resident physician in the department of neurology at the Hospital of the University of Pennsylvania, said during her presentation. “[Prior research] demonstrated increased risk of attempted suicide among individuals with migraine.”

Elser and colleagues sought to examine the risk of attempted and completed suicide across headache disorders in a Scandinavian population, as a prior body of knowledge is incomplete.

Their population-based cohort study collected data from Danish population-based registries from 1995 to 2018 to include 64,057 individuals diagnosed with migraine; 40,160 diagnosed with tension-type headache (TTH); 5,743 diagnosed with trigeminal and autonomic cephalalgias (TAC); and with 4,253 with post-traumatic headache diagnosis.

Individuals with headache diagnoses were then matched 5:1 on sex and birth year to controls without headache. Index date for the headache group was defined as date of first diagnosis among persons aged 15 years and older.

The researchers utilized Fine and Gray models accounting for competing risk of death from other causes to compute hazard ratios for the association of headache with attempted and completed suicide, adjusting for age, gender, year, education, income and other factors.

Elser and colleagues wrote that they observed increased rates of attempted suicide (migraine: HR = 2.12, 95% CI: 1.89–2.37; TTH: HR = 2.22, 95% CI: 1.93–2.55; TAC: 2.95, 95% CI: 1.99–4.36; post-traumatic headache: HR = 2.79, 95% CI: 1.71–4.54) among those with headache and those who completed suicide (migraine: HR = 1.39, 95% CI: 1.09–1.78; TTH: HR = 1.89, 95% CI: 1.46–2.46; TAC: HR = 2.18, 95% CI: 1.34-3.55; post-traumatic headache: HR = 4.62, 95% CI: 1.67–12.8) compared with the general population.

“I think it’s unlikely these results are perfectly generalizable to other geographic or cultural contexts,” Elser said. “The results nevertheless suggest a unique risk among headache patients for attempted and completed suicide.”