PHILADELPHIA— Individuals diagnosed with several types of headache disorders – ranging from mild-to-moderate to severe – attempt and complete suicide at higher rates than those without headache diagnoses, according to new research from the Perelman School of Medicine at the University of Pennsylvania. Their analysis found that overall, people with headache diagnoses attempted suicide at over twice the rate and completed suicide at 1.4 times the rate of those without headache disorders, and that even individuals with mild headaches displayed an increased rate of suicide. As a result of findings, published this week in JAMA Neurology, researchers suggest that all patients with headache should be screened for symptoms of depression and suicidal thoughts.
"We don't exactly know why there's an association between headaches and suicide, but our research lays the groundwork for future work into the complicated relationship between headaches and other psychiatric disorders. Bad headaches can lead to feelings of hopelessness or demoralization, or worse, as we have found," said first author, Holly Elser, MD, PhD, a resident in the department of Neurology. "There is a clear need for future research that can further explore this link, and at present there is a clear need for prompt identification and treatment of psychiatric symptoms in our headache patients."
Potential impact on billions of people
Headaches are one of the most common disorders, with billions diagnosed worldwide. People with headache disorders often also have psychiatric disorders at the same time, like anxiety disorders, substance use disorders, and depression. Earlier research suggested an increased rate of suicidal thoughts and behavior in individuals with severe headache disorders, but up until now, there has been little research regarding the risk of suicide across the range of headache disorders, including tension-type headache which is among the most common and mild forms of headache.
Researchers accessed health data from the Danish National Health Registers, which has collected information from all Danish citizens since the late 1970s. For this study, researchers analyzed the health records of a group of Danish citizens over 15 years old between 1995 and 2020. They used diagnostic codes from the ICD-10 to identify individuals diagnosed with four types of headache disorders, ranging from milder headache types like tension-type headaches (TTH), to more severe, like migraines and trigeminal autonomic cephalalgia (TAC). Headaches from head injury, called post-traumatic headaches, were also included. For comparison, the researchers matched each person diagnosed with headache to five individuals of the same sex and birth year without a headache diagnosis. Their cohort included 119,486 diagnosed with headache, and 597,430 without.
The researchers also used ICD-10 codes to identify those who attempted and completed suicide. Their analysis found that overall, people with headache diagnoses attempted suicide at over twice the rate of individuals without, and completed suicide at 1.4 times the rate of the control group. They found rates of suicide attempt and completion elevated even among those diagnosed with less-severe headache disorders like TTH, with rates of 1.91 and at 1.4 that of those without headache, respectively. The strongest associations between headache diagnoses and suicide were for post-traumatic headache, who attempted and completed suicide at three times the rate of the control group, and TAC, who attempted and completed suicide at 1.94 times and 2.4 times the rate of the control group.
"Headaches alone can be treated differently than headaches in conjunction with other psychiatric disorders. For instance, the appropriate management of depression often requires higher doses of antidepressants than used for headaches alone, or uses a different class of medication entirely,"
said Elser. "Our analysis can help clinicians better treat their patients with all types of headaches, taking their mental health treatment into account as well as their headache symptoms."
