Headaches linked to an increased risk for attempted, completed suicide

Key takeaways:

• People diagnosed with headaches demonstrated a higher risk for suicidality vs. a comparison group.
• TACs and post-traumatic headaches significantly increased the risk for attempted and completed suicide.

People diagnosed with headache had a greater risk for attempting and completing suicide, according to results of a cohort study published in JAMA Neurology.

Certain headache types increased suicidality risk even more, while screening and early identification of depression symptoms and suicidality “may help to identify patients with headache who are at elevated suicide risk,” Holly Elser, MD, PhD, MPH, a neurology resident at the University of Pennsylvania, told Healio.

Suicides made up the majority of violent deaths in the United States in 2021 while reaching a new annual high in the following year.

Prior research has suggested links between suicidality and headaches, especially the cluster and migraine types, but the mechanisms behind these associations “are uncertain for several reasons,” Elsner and colleagues wrote.

For example, “a complex, bidirectional relation may exist between headache and psychiatric comorbidities,” they added, while “alterations in serotonergic mechanisms and production of inflammatory cytokines may serve as a common cause of some headache disorders and psychiatric symptoms.”

Such uncertainty “leaves important questions unanswered,” the researchers wrote.

To help fill these research gaps , Elsner and colleagues conducted a population-based cohort study where they matched 119,486 Danish people aged 15 years or older who were diagnosed with headache with 597,430 people drawn from the country’s general population.

The researchers, in addition to looking at the risks for attempted and completed suicide tied to headache, also examined links among different headache subtypes like migraine, tension-type headache, trigeminal autonomic cephalalgia (TAC) and post-traumatic headache disorder.

They found a 15-year absolute risk (AR) for attempted suicide among people diagnosed with headache of 0.78% (95% CI, 0.72%-0.85%) vs. 0.33% (95% CI, 0.31%-0.35%) in the comparison cohort (risk difference [RD] = 0.45%; 95% CI, 0.39%-0.53%).

Meanwhile, they reported a 15-year AR of completed suicide of 0.21% (95% CI, 0.17%-0.24%) in those diagnosed with headache and 0.15% (95% CI, 0.13%-0.16%) in the comparison cohort (RD = 0.06%; 95% CI, 0.02%-0.1%).

Researchers also observed higher risk for attempted suicide (HR = 2.04; 95% CI, 1.84-2.27) and completed suicide (HR = 1.4; 95% CI, 1.17-1.68) among those diagnosed with headache vs. comparison cohort members.

Attempted and completed suicide risks appeared similar between men and women and consistent across headache types, with greater associations seen for:

• TACs (attempted suicide: HR = 1.97; 95% CI, 1.35-2.87; completed suicide: HR = 2.4; 95% CI, 1.23-4.66); and
• post-traumatic headache (attempted suicide: HR = 3.14; 95% CI, 1.81-5.47; completed suicide: HR = 3.22; 95% CI, 1.4-7.4).

Treatment with antidepressants attenuated the higher risk for attempted, but not completed, suicide. 

Elser told Healio that patients diagnosed with headache with comorbid psychiatric symptoms “may benefit in particular from co-management with behavioral health specialists.”

The researchers identified multiple study limitations, such as possible misclassification of headache subtypes.

Regarding future research, “for me, findings from this study naturally raise the question of whether treatment of the headache, psychiatric symptoms, or both attenuates the risk of attempted and completed suicide in persons diagnosed with headache,” Elser said.