To examine the risk of attempted and completed suicide across headache disorders

Although headache disorders are highly comorbid with psychiatric illnesses, we know of no prior study that examines rates of attempted and completed suicide across headache disorders.

This population-based cohort study leverages prospectively, routinely collected data from Danish population-based registries from 1995–2018 to examine the risk of attempted and completed suicide among individuals with hospital-diagnosed migraine, tension-type headache (TTH), trigeminal and autonomic cephalalgias (TAC), and post-traumatic headache diagnosis. Index date was defined as date of first headache diagnosis among persons aged ≥15 years. Individuals with headache diagnoses were matched 5:1 on sex and birth year to individuals without headache diagnoses. Using Fine and Gray models accounting for competing risk of death from other causes, we computed hazard ratios (HRs) for the association of headache with attempted and completed suicide, adjusting for age, gender, year, Charlson Comorbidity Index score, cohabitation status, education, and income.  

The study population included 64,057 individuals diagnosed with migraine, 40,160 diagnosed with TTH, 5,743 diagnosed with TAC, and 4,253 diagnosed with post-traumatic headache during the study period and matched persons without a diagnosis of headache. Among individuals diagnosed with headache, we 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) and 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) versus members of the general population without a hospital-based diagnosis of headache.

We found a robust association with attempted and completed suicide across headache disorders. Complementary psychiatric evaluation and treatment may therefore be particularly important for individuals diagnosed with headache.