Risk of depression and suicide in adults with pre-existing primary headaches

Primary headaches, particularly tension-type headaches (TTH) and migraine, are common and are associated with several comorbidities, including psychiatric conditions such as depression and suicide. However, there is limited evidence on the temporal relationship between primary headaches and subsequent depression and suicide, and most prior research has relied on self-reported data or cross-sectional designs. This population-based retrospective cohort study used data from the National Health Insurance Service-National Health Screening Cohort and involved 459,347 participants. Cox proportional hazards regression models were employed to compute adjusted hazard ratios (aHR) with 95 % confidence intervals (CI) for the risk of depression and suicide from 2006 to 2019 according to exposure to primary headaches from 2002 to 2005. Primary headaches were significantly associated with an elevated risk of depression (aHR for TTH = 1.55; 95 % CI = 1.49-1.62, aHR for migraine = 1.50; 95 % CI = 1.45-1.55) in both men and women. Tension-type headache was linked to a higher risk of suicide with statistical significance in men (aHR = 1.39; 95 % CI = 1.00-1.94), but not in women (aHR = 1.11; 95 % CI = 0.73-1.69). Migraine was not significantly associated with suicide (aHR = 1.16; 95 % CI = 0.91-1.46). Primary headaches are associated with an increased risk of depression in both men and women. Tension-type headache is related to an elevated risk of suicide in men. These findings highlight the need for comprehensive management of headache disorders that addresses both the physical and mental health aspects, not only in women but also in the male population.