{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:51:14Z","timestamp":1787802674169,"version":"build-2784847793"},"reference-count":55,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"Importance<\/jats:title>Although past research suggests an association between migraine and attempted suicide, there is limited research regarding risk of attempted and completed suicide across headache disorders.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the risk of attempted and completed suicide associated with diagnosis of migraine, tension-type headache, posttraumatic headache, and trigeminal autonomic cephalalgia (TAC).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This was a population-based cohort study of Danish citizens from 1995 to 2020. The setting was in Denmark, with a population of 5.6 million people. Persons 15 years and older who were diagnosed with headache were matched by sex and birth year to persons without headache diagnosis with a ratio of 5:1. Data analysis was conducted from May 2023 to May 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>First-time headache diagnoses identified from inpatient hospitalizations, emergency department visits, and outpatient specialty clinic visits using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision <\/jats:italic>(ICD-10<\/jats:italic>) codes.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Diagnostic codes from the ICD-10<\/jats:italic> were used to identify attempted suicide from the Danish National Patient Registry and the Danish Psychiatric Central Research Register and completed suicides from the Danish Register of Causes of Death. Absolute risks (ARs) and risk differences (RDs) for attempted and completed suicide were calculated using the cumulative incidence function. Hazard ratios (HRs) for attempted and completed suicide associated with headache diagnosis were computed adjusting for age, sex, year, education, income, baseline comorbidities, and accounting for competing risk of death.<\/jats:p><\/jats:sec>Results<\/jats:title>In total, 119\u202f486 persons (83\u202f046 female [69.5%]) diagnosed with headache were identified and matched with 597\u202f430 persons (415\u202f230 female [69.5%]) drawn from the general population. Participants\u2019 median (IQR) age was 40.1 (29.1-51.6) years. The 15-year AR of attempted suicide among persons diagnosed with headache was 0.78% (95% CI, 0.72%-0.85%) vs 0.33% (95% CI, 0.31%-0.35%) in the comparison cohort (RD,\u20090.45%; 95% CI, 0.39%-0.53%). The 15-year AR of completed suicide among persons diagnosed with headache was 0.21% (95% CI, 0.17%-0.24%) vs 0.15% (95% CI, 0.13%-0.16%) in the comparison cohort (RD,\u20090.06%; 95% CI, 0.02%-0.10%). The hazards of attempted suicide (HR,\u20092.04; 95% CI, 1.84-2.27) and completed suicide (HR,\u20091.40; 95% CI, 1.17-1.68) were elevated among persons with headache vs comparison cohort members. Findings were consistent across headache types, with stronger associations for TACs and posttraumatic headache.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Results of this cohort study revealing the robust and persistent association of headache diagnoses with attempted and completed suicide suggest that behavioral health evaluation and treatment may be important for these patients.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaneurol.2024.4974","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T16:00:44Z","timestamp":1738598444000},"page":"276","source":"Crossref","is-referenced-by-count":6,"title":["Risk of Attempted and Completed Suicide in Persons Diagnosed With Headache"],"prefix":"10.1001","volume":"82","author":[{"given":"Holly","family":"Elser","sequence":"first","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark"},{"name":"Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia"},{"name":"Editorial Fellow, JAMA Neurology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00f3ra K\u00f6rmendin\u00e9","family":"Farkas","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia Hvitfeldt","family":"Fuglsang","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sissel Toft","family":"S\u00f8rensen","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark"},{"name":"Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik Toft","family":"S\u00f8rensen","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark"},{"name":"Clinical Excellence Research Center, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"11","key":"noi240091r1","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1016\/S1474-4422(18)30322-3","article-title":"Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.","volume":"17","author":"Stovner","year":"2018","journal-title":"Lancet Neurol"},{"issue":"1","key":"noi240091r2","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s10194-022-01402-2","article-title":"The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates.","volume":"23","author":"Stovner","year":"2022","journal-title":"J Headache Pain"},{"issue":"1","key":"noi240091r3","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/s10194-021-01264-0","article-title":"The relationship between headache-attributed disability and lost productivity: 1. a review of the literature.","volume":"22","author":"Kothari","year":"2021","journal-title":"J Headache Pain"},{"issue":"6","key":"noi240091r4","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1097\/00043764-200206000-00013","article-title":"The economic burden of lost productivity due to migraine headache: a specific worksite analysis.","volume":"44","author":"Burton","year":"2002","journal-title":"J Occup Environ Med"},{"issue":"12","key":"noi240091r5","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1007\/s10654-005-3778-5","article-title":"Secular changes in health care utilization and work absence for migraine and tension-type headache: a population based study.","volume":"20","author":"Lyngberg","year":"2005","journal-title":"Eur J Epidemiol"},{"issue":"4","key":"noi240091r6","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1136\/jech.46.4.443","article-title":"Impact of headache on sickness absence and utilization of medical services: a Danish population study.","volume":"46","author":"Rasmussen","year":"1992","journal-title":"J Epidemiol Community Health"},{"issue":"4","key":"noi240091r7","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1097\/00043764-199704000-00009","article-title":"Lost workdays and decreased work effectiveness associated with headache in the workplace.","volume":"39","author":"Schwartz","year":"1997","journal-title":"J Occup Environ Med"},{"issue":"2","key":"noi240091r8","doi-asserted-by":"publisher","first-page":"197","DOI":"10.18553\/jmcp.2023.29.2.197","article-title":"Relationships between headache frequency, disability, and disability-related unemployment among adults with migraine.","volume":"29","author":"Shapiro","year":"2023","journal-title":"J Manag Care Spec Pharm"},{"key":"noi240091r9","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1007\/s10072-013-1378-9","article-title":"Disability and quality of life in headache: where we are now and where we are heading.","volume":"34","author":"D\u2019Amico","year":"2013","journal-title":"Neurol Sci"},{"issue":"5","key":"noi240091r10","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1111\/j.1526-4610.2005.05101.x","article-title":"Headache and psychiatric comorbidity: historical context, clinical implications, and research relevance.","volume":"45","author":"Lake","year":"2005","journal-title":"Headache"},{"issue":"5","key":"noi240091r11","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1111\/j.1526-4610.2012.02117.x","article-title":"Migraine headaches and suicide attempt.","volume":"52","author":"Breslau","year":"2012","journal-title":"Headache"},{"issue":"2","key":"noi240091r12","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1212\/WNL.42.2.392","article-title":"Migraine, suicidal ideation, and suicide attempts.","volume":"42","author":"Breslau","year":"1992","journal-title":"Neurology"},{"issue":"6","key":"noi240091r13","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1016\/j.genhosppsych.2008.09.003","article-title":"Pain and suicidal thoughts, plans and attempts in the US.","volume":"30","author":"Ilgen","year":"2008","journal-title":"Gen Hosp Psychiatry"},{"key":"noi240091r14","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.jad.2020.08.019","article-title":"Prevalence of suicidal ideation and suicide attempt in patients with migraine: a systematic review and meta-analysis.","volume":"277","author":"Pei","year":"2020","journal-title":"J Affect Disord"},{"issue":"2","key":"noi240091r15","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/s11916-006-0025-z","article-title":"Cluster headache: myths and the evidence.","volume":"10","author":"Markley","year":"2006","journal-title":"Curr Pain Headache Rep"},{"issue":"2","key":"noi240091r16","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s11916-012-0313-8","article-title":"The psychiatric comorbidities of cluster headache.","volume":"17","author":"Robbins","year":"2013","journal-title":"Curr Pain Headache Rep"},{"issue":"1","key":"noi240091r17","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1111\/j.1526-4610.2011.02028.x","article-title":"Cluster headache in the US: demographics, clinical characteristics, triggers, suicidality, and personal burden.","volume":"52","author":"Rozen","year":"2012","journal-title":"Headache"},{"issue":"1","key":"noi240091r18","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/S1474-4422(17)30405-2","article-title":"Diagnosis, pathophysiology, and management of cluster headache.","volume":"17","author":"Hoffmann","year":"2018","journal-title":"Lancet Neurol"},{"issue":"11","key":"noi240091r19","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1212\/01.wnl.0000325565.63526.d2","article-title":"Clinical course in migraine: conceptualizing migraine transformation.","volume":"71","author":"Bigal","year":"2008","journal-title":"Neurology"},{"issue":"1","key":"noi240091r20","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s10194-021-01241-7","article-title":"Demoralization predicts suicidality in patients with cluster headache.","volume":"22","author":"Koo","year":"2021","journal-title":"J Headache Pain"},{"issue":"3","key":"noi240091r21","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1097\/AJP.0b013e31815ca2a3","article-title":"Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective.","volume":"24","author":"Ratcliffe","year":"2008","journal-title":"Clin J Pain"},{"issue":"4","key":"noi240091r22","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1007\/s10194-009-0134-2","article-title":"Psychiatric comorbidity in patients with chronic daily headache and migraine: a selective overview including personality traits and suicide risk.","volume":"10","author":"Pompili","year":"2009","journal-title":"J Headache Pain"},{"issue":"1","key":"noi240091r23","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/0165-1781(91)90102-U","article-title":"Migraine, psychiatric disorders, and suicide attempts: an epidemiologic study of young adults.","volume":"37","author":"Breslau","year":"1991","journal-title":"Psychiatry Res"},{"key":"noi240091r24","doi-asserted-by":"publisher","first-page":"81","DOI":"10.2147\/NDT.S8467","article-title":"Psychiatric comorbidity and suicide risk in patients with chronic migraine.","volume":"6","author":"Pompili","year":"2010","journal-title":"Neuropsychiatr Dis Treat"},{"issue":"1","key":"noi240091r25","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1111\/head.12710","article-title":"Migraine headache and risk of self-harm and suicide: a population-based study in Ontario, Canada.","volume":"56","author":"Colman","year":"2016","journal-title":"Headache"},{"issue":"7","key":"noi240091r26","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1001\/jamapsychiatry.2013.908","article-title":"Noncancer pain conditions and risk of suicide.","volume":"70","author":"Ilgen","year":"2013","journal-title":"JAMA Psychiatry"},{"issue":"5","key":"noi240091r27","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1177\/0141076814522033","article-title":"Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage.","volume":"107","author":"Singhal","year":"2014","journal-title":"J R Soc Med"},{"key":"noi240091r28","doi-asserted-by":"publisher","first-page":"563","DOI":"10.2147\/CLEP.S179083","article-title":"The Danish health care system and epidemiological research: from health care contacts to database records.","volume":"11","author":"Schmidt","year":"2019","journal-title":"Clin Epidemiol"},{"key":"noi240091r29","doi-asserted-by":"publisher","first-page":"449","DOI":"10.2147\/CLEP.S91125","article-title":"The Danish National Patient Registry: a review of content, data quality, and research potential.","volume":"7","author":"Schmidt","year":"2015","journal-title":"Clin Epidemiol"},{"issue":"7","key":"noi240091r30","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1177\/1403494810395825","article-title":"The Danish psychiatric central research register.","volume":"39","author":"Mors","year":"2011","journal-title":"Scand J Public Health"},{"issue":"7","key":"noi240091r31","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1177\/1403494811399958","article-title":"The Danish register of causes of death.","volume":"39","author":"Helweg-Larsen","year":"2011","journal-title":"Scand J Public Health"},{"issue":"11","key":"noi240091r32","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009120","article-title":"Are suicide deaths under-reported: nationwide reevaluations of 1800 deaths in Scandinavia.","volume":"5","author":"T\u00f8llefsen","year":"2015","journal-title":"BMJ Open"},{"issue":"7488","key":"noi240091r34","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1136\/bmj.330.7488.373","article-title":"Suicide, depression, and antidepressants.","volume":"330","author":"Cipriani","year":"2005","journal-title":"BMJ"},{"issue":"1","key":"noi240091r35","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1056\/NEJMra1802148","article-title":"Understanding links among opioid use, overdose, and suicide.","volume":"380","author":"Bohnert","year":"2019","journal-title":"N Engl J Med"},{"issue":"7","key":"noi240091r36","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1177\/1403494810394717","article-title":"The Danish national prescription registry.","volume":"39","author":"Kildemoes","year":"2011","journal-title":"Scand J Public Health"},{"issue":"1","key":"noi240091r37","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/S1474-4422(16)30293-9","article-title":"Sex differences in the epidemiology, clinical features, and pathophysiology of migraine.","volume":"16","author":"Vetvik","year":"2017","journal-title":"Lancet Neurol"},{"issue":"6","key":"noi240091r38","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1111\/j.1526-4610.2011.01904.x","article-title":"Sex-related differences in epidemiological and clinic-based headache studies.","volume":"51","author":"Macgregor","year":"2011","journal-title":"Headache"},{"issue":"5","key":"noi240091r39","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1001\/jama.279.5.381","article-title":"Epidemiology of tension-type headache.","volume":"279","author":"Schwartz","year":"1998","journal-title":"JAMA"},{"issue":"12","key":"noi240091r40","doi-asserted-by":"publisher","first-page":"e1207","DOI":"10.1212\/WNL.0000000000201688","article-title":"Sex differences in clinical features, treatment, and lifestyle factors in patients with cluster headache.","volume":"100","author":"Fourier","year":"2023","journal-title":"Neurology"},{"issue":"6","key":"noi240091r41","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1192\/bjp.177.6.484","article-title":"Sex and suicide\u2014gender differences in suicidal behavior.","volume":"177","author":"Hawton","year":"2000","journal-title":"Br J Psychiatry"},{"issue":"12","key":"noi240091r42","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0296324","article-title":"Suicide trends in Denmark: an ecological study exploring suicide methods from 1995 to 2019.","volume":"18","author":"Konieczna","year":"2023","journal-title":"PLoS One"},{"issue":"1","key":"noi240091r43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.psym.2019.08.009","article-title":"Suicide risk screening in the hospital setting: a review of brief validated tools.","volume":"61","author":"Thom","year":"2020","journal-title":"Psychosomatics"},{"key":"noi240091r44","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.jad.2018.02.045","article-title":"The PHQ-9 Item 9\u2013based screening for suicide risk: a validation study of the Patient Health Questionnaire (PHQ)-9 Item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS).","volume":"232","author":"Na","year":"2018","journal-title":"J Affect Disord"},{"key":"noi240091r45","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/j.jad.2020.09.131","article-title":"Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): a systematic review.","volume":"279","author":"Costantini","year":"2021","journal-title":"J Affect Disord"},{"issue":"12","key":"noi240091r46","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.1176\/appi.ajp.2011.10111704","article-title":"The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from 3 multisite studies with adolescents and adults.","volume":"168","author":"Posner","year":"2011","journal-title":"Am J Psychiatry"},{"issue":"4 Headache","key":"noi240091r47","first-page":"973","article-title":"Preventive migraine treatment.","volume":"21","author":"Silberstein","year":"2015","journal-title":"Continuum (Minneap Minn)"},{"issue":"4","key":"noi240091r48","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1007\/s11940-019-0557-2","article-title":"Antidepressants for preventive treatment of migraine.","volume":"21","author":"Burch","year":"2019","journal-title":"Curr Treat Options Neurol"},{"key":"noi240091r49","doi-asserted-by":"publisher","first-page":"2629","DOI":"10.2147\/JPR.S322432","article-title":"Suicide attempts in US veterans with chronic headache disorders: a 10-year retrospective cohort study.","volume":"14","author":"Androulakis","year":"2021","journal-title":"J Pain Res"},{"key":"noi240091r50","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.jocn.2019.08.084","article-title":"Suicidality and its risk factors in tension-type headache patients: a multicenter case-control study.","volume":"69","author":"Seo","year":"2019","journal-title":"J Clin Neurosci"},{"issue":"9","key":"noi240091r51","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1111\/head.13127","article-title":"Clinical characteristics and treatment patterns among patients diagnosed with cluster headache in US health care claims data.","volume":"57","author":"Choong","year":"2017","journal-title":"Headache"},{"issue":"5","key":"noi240091r52","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1017\/S0033291705006859","article-title":"Suicidality in chronic pain: a review of the prevalence, risk factors, and psychological links.","volume":"36","author":"Tang","year":"2006","journal-title":"Psychol Med"},{"issue":"6","key":"noi240091r53","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1521\/suli.2010.40.6.597","article-title":"Severe pain predicts greater likelihood of subsequent suicide.","volume":"40","author":"Ilgen","year":"2010","journal-title":"Suicide Life Threat Behav"},{"issue":"4","key":"noi240091r54","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1136\/jnnp.2009.192492","article-title":"Sociodemographic and comorbidity profiles of chronic migraine and episodic migraine sufferers.","volume":"81","author":"Buse","year":"2010","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"noi240091r33","volume-title":"The Danish Integrated Database for Labor Market Research: Towards Demystification for the English-Speaking Audience","author":"Timmermans","year":"2010"},{"key":"noi240091r55","unstructured":"World Health Organization. Suicide mortality rate (per 100 000 population). Accessed November 1, 2024. https:\/\/data.who.int\/indicators\/i\/F08B4FD\/16BBF41"}],"container-title":["JAMA Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaneurology\/articlepdf\/2829961\/jamaneurology_elser_2025_oi_240091_1740679288.72602.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T15:01:56Z","timestamp":1741618916000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaneurology\/fullarticle\/2829961"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,1]]},"references-count":55,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaneurol.2024.4974","relation":{},"ISSN":["2168-6149"],"issn-type":[{"value":"2168-6149","type":"print"}],"subject":[],"published":{"date-parts":[[2025,3,1]]}}}