Results of a 25-year study: how different types of headaches are linked to suicide risk

Researchers from Aarhus University have found that patients with migraine, tension headache, post-traumatic headache and Trigeminal Autonomic Cephalalgia (TAC) are at a higher risk.

According to statistics, about 66.6 per cent of the world's population suffers from headaches. At the same time, they are often joined by mental disorders. Previously it was known about the relationship between migraine and suicidal thoughts, but data covering all types of headaches, until now, there was a lack of data. The new study, however, gives a more complete picture regarding suicidal risk in different categories of patients.

Study Design

The paper, "Risk of Attempted and Completed Suicide in Persons Diagnosed With Headache," published in JAMA Neurology, covered the period from 1995 to 2020 and included Danes aged 15 years and older. All patients with a first-time diagnosis of headache (119,486 people) were compared with a control group of 597,430 people without similar diagnoses (5:1 ratio). Headache types such as migraine, tension headache, post-traumatic headache and trigeminal autonomic cephalalgia (ICD-10 classification) were taken into account.

Results

• Suicide attempts
  Over 15 years, the absolute risk among people with headache was 0.78%, compared with 0.33% in the control group. The difference in risk (0.45%) indicates a significant increase in the likelihood of attempts.
• Completed suicides
  The absolute 15-year risk for headache patients reached 0.21% versus 0.15% for healthy participants, giving a difference of 0.06%. After adjustment for comorbidities, the risk remained higher (hazard ratio, HR, for attempts was 2.04 and for deaths was 1.40).

Individual types of pain disorders were additionally studied:

• Migraine: HR 1.71 for attempts and 1.09 for completed suicides.
• Tension headache: HR 1.91 (attempts) and 1.44 (completed cases).
• Posttraumatic headache: HR 3.14 (attempts) and 3.22 (completed cases).
• Trigeminal Autonomic Cephalalgia (TAC): HR 1.97 (attempts) and 2.40 (completed cases).

Impact of comorbidities

Patients with headache were more likely to have other health problems: cancer, cardiovascular and pulmonary disease (COPD), strokes, head injuries, mood disorders, addictions, and others. Even with these diagnoses taken into account, the increased risk of suicide in people with headaches remained. In patients with pre-existing mental disorders (depression, addictions), the association was reduced but still significant. Increased risk was found regardless of gender, age, income or education level.

Conclusions and recommendations

The authors emphasise that timely psychological and behavioural support for patients with any of the above types of headaches is essential. The results of the study point to the need for early risk assessment and active accompaniment in a group of people suffering from these disorders.

Source:
Holly Elser et al, Risk of Attempted and Completed Suicide in Persons Diagnosed With Headache, JAMA Neurology (2025). DOI: 10.1001/jamaneurol.2024.4974