A recent large-scale study has uncovered a troubling association between headaches and an elevated risk of both attempted and completed suicide.
While previous research primarily focused on migraines, this new study highlights that individuals suffering from various forms of headaches, — even those perceived as less severe — face a heightened risk of suicide.
Led by Holly Elser, MD, PhD, a neurology resident at Penn Medicine in Philadelphia, the research brings much-needed attention to the complex relationship between chronic pain and mental health.
Expanding the Scope: More Than Just Migraine
Although earlier studies had already established a link between migraines and suicide risk, Dr. Elser and her team broadened their focus to include four different types of headaches.
These were migraines, tension-type headaches, post-traumatic headaches, and trigeminal autonomic cephalalgias (a group that includes cluster headaches). What they found was striking: even less painful types of headaches could increase the likelihood of suicide attempts and completions.
“In particular, we find that patients diagnosed with tension-type headache — which is highly prevalent and typified by mild-to-moderate symptoms — experience elevated risk of attempted and completed suicide as compared with members of the general population without a diagnosis of headache,” explains Dr. Elser.
This finding is significant, given that tension-type headaches are extremely common. It’s estimated that 70 percent of people experience them occasionally or frequently. These headaches typically manifest as a sensation of pressure around the forehead and temples, often described as a tight band squeezing the head.
A Comprehensive Study With Alarming Results
The study in question analyzed data from Denmark, following more than 119,000 individuals diagnosed with headaches. These participants were compared to a control group of over 597,000 people without any headache diagnosis. The researchers tracked these individuals for 15 years, relying on diagnostic codes to document suicide attempts and utilizing death registries to record completed suicides.
Importantly, the investigators accounted for variables that could influence their results. Factors such as age, sex, educational attainment, income, and other health conditions were adjusted for in their analysis. Despite these adjustments, the findings were still stark.
Among people diagnosed with headaches, 7.8 out of every 1,000 attempted suicide, and 2.1 out of every 1,000 died by suicide. In contrast, only 3.3 out of 1,000 people in the general population attempted suicide, and 1.5 out of 1,000 completed suicide.
The highest risk was seen in those diagnosed with post-traumatic headaches, who had a 214 percent higher risk of attempting suicide compared with those in the general population. Post-traumatic headaches often follow head injuries or trauma, such as concussions or whiplash.
These headaches can be persistent and debilitating, sometimes lasting for weeks or even months after the initial injury. Additional symptoms like dizziness, nausea, and light sensitivity frequently accompany the head pain.
The Severity and Setting of Diagnosis Matter
Another noteworthy finding was that individuals diagnosed with headaches in emergency settings faced an even higher risk of suicide attempts and completions. This suggests that both the severity and complexity of headache disorders play a critical role in suicide risk.
As the researchers noted, these cases often involve more severe forms of headache, potentially coupled with urgent or complex medical needs.
“This study was not limited to only migraine, and the association of suicide with tension-type headache is an important addition to our understanding of the suicide risks of patients with headaches and chronic pain,” remarks Timothy Collins, MD, chief of the headache and pain division of the neurology department at Duke University School of Medicine in Durham, North Carolina.
Although Dr. Collins was not involved in the study, he emphasized the value of this broader focus.
Understanding the Link Between Headaches and Suicide Risk
While the study did not directly investigate why headaches increase suicide risk, Dr. Elser points to several theories. She highlights a potentially complex, bidirectional relationship between headaches and mental health disorders.
“The headaches may worsen in response to psychiatric symptoms, and worsening of headache can lead to feelings of hopelessness or demoralization,” she explains.
This cyclical dynamic may exacerbate both the physical pain and the emotional suffering that individuals with chronic headaches experience.
Additionally, chronic pain conditions, including headaches, are consistently linked to an increased risk of suicide. Previous research has shown that people living with chronic pain are twice as likely to die by suicide compared to those without chronic pain.
There may also be shared biological factors contributing to both headaches and psychiatric symptoms. For example, increased inflammation and changes in the release of serotonin — a neurotransmitter involved in mood regulation, sleep, and appetite — could play a role in both conditions.
“It is interesting that the use of opioids was higher in all headache groups versus the control group, despite evidence-based guidelines that opioids are not appropriate treatment for headaches, and research showing that chronic opioid therapy is associated with an increased risk of suicide,” says Dr. Collins.
This observation raises further concerns about pain management strategies and their potential unintended consequences.
The Importance of Screening for Depression and Suicidal Thoughts
Both Dr. Elser and Dr. Collins stress the importance of early detection and intervention.
“Screening and early recognition of depressive symptoms and suicidality may help to identify patients with headache who are at elevated suicide risk,” says Dr. Elser.
She emphasizes that patients diagnosed with headaches who also show signs of psychiatric disorders could particularly benefit from collaborative care that includes behavioral health specialists.
Dr. Collins echoes this sentiment, underscoring that the most significant risk factor is the coexistence of depression. As such, he recommends that all individuals with newly diagnosed headache disorders undergo screening for depression and suicidal thoughts as part of their routine medical care.
Hope Through Treatment and Support
Despite the concerning statistics, experts agree that help is available for those suffering from headaches and associated mental health challenges. Dr. Collins encourages individuals experiencing headaches — whether newly diagnosed or chronic — to seek care from a specialist.
“There are so many headache-specific treatments that can be used to treat headaches. Most of the time, improved headaches with decreased pain significantly improves depressed mood,” he explains.
Treatment options may include preventive medications, non-drug therapies like cognitive-behavioral therapy (CBT), lifestyle changes, and newer interventions such as nerve blocks or neuromodulation devices. Accessing these treatments not only helps manage headache symptoms but can also alleviate the emotional toll associated with chronic pain.
Final Thoughts
The new findings highlight the urgent need for healthcare providers to consider the mental health of patients who suffer from headaches. While the physical pain is often the focus of treatment, the psychological burden can be just as severe.
By integrating mental health care into headache management plans, clinicians may be able to prevent needless suffering — and potentially save lives.