Headache Type Tied to Increased Depression, Suicide Risk

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TOPLINE:

Primary headaches were associated with a 38% increased risk for depression in both men and women, while tension-type headache (TTH) was associated with a significantly increased risk for suicide — but only in men — a new retrospective cohort study showed.

METHODOLOGY:

• Researchers conducted a population-based retrospective cohort study using data from the National Health Insurance Service-National Health Screening Cohort database from 2002 to 2019 in South Korea.
• They included more than 192,000 participants (mean age, 52 years; 54% men) with primary headaches (TTH or migraine) who were followed from 2006 until the onset of depression, suicide, death, or end of the study period, whichever came first.
• Depression was defined as attending at least two outpatient psychiatry visits or at least one hospitalization for a depressive episode or recurrent depressive disorder; suicide was defined as death from intentional self-harm, independent of depression.
• Participants were age- and sex-matched to nearly 460,000 individuals without primary headaches. Covariates included demographics, lifestyle habits, clinical characteristics, and the Charlson Comorbidity Index.

TAKEAWAY:

• In the full group with preexisting headache, an elevated risk for depression was associated with TTH (adjusted hazard ratio [aHR], 1.55), migraine (aHR, 1.5), and all-type primary headaches (aHR, 1.4; P < .05 all comparisons).
• Preexisting headaches were also associated with an increased risk for depression in both men (aHR, 1.4; 95% CI, 1.4-1.5) and women (aHR, 1.35; 95% CI, 1.3-1.4).
• TTH was associated with a significantly increased risk for suicide in men (aHR, 1.4; 95% CI, 1.0-1.9) but not in women (aHR, 1.1).
• Migraine was not significantly associated with the risk for suicide.

IN PRACTICE:

“This suggests the negative influence of headaches on emotional health and the need to consider active treatment addressing both the headache symptom itself and the burden on mental health, not only in women but also in men,” the investigators wrote.

SOURCE:

This study was led by Back Kim, Seoul National University Graduate School, Seoul, Republic of Korea. It was published online on September 26 in the Journal of Psychiatric Research.

LIMITATIONS:

The study’s retrospective nature prevented direct confirmation of causal associations between primary headaches and depression or suicide. The reliance on diagnostic codes may have potentially missed asymptomatic patients with headaches who did not seek medical attention. Additionally, the number of suicide events was small, particularly when analyzed by sex. The analysis did not consider headache frequency, intensity, duration, or medication use. The study also did not use all the variables in the database and lacked information on emigration from South Korea. 

DISCLOSURES:

This study was partially funded by a National Research Foundation Korea grant from the South Korean government. The investigators reported having no relevant conflicts of interest.

 

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