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Cluster headache suicidality: a systematic review with a meta-analysis.

E K Van Obberghen¹, R Fabre^1,2, M Lanteri-Minet^3,4

¹Pain Department, FHU InovPain, UR2CA-PIN, CHU Nice and Côte d'Azur University, Nice, France.

The Journal of Headache and Pain

|December 4, 2025

Summary

This summary is machine-generated.

Cluster headache (CH) patients exhibit increased suicidal ideation and attempts, particularly those in specialized care. This risk is linked to CH severity and psychological factors like demoralization.

Keywords:

Burden Cluster headache Suicidal ideation Suicide attempts

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Area of Science:

Neurology
Psychiatry
Public Health

Background:

Cluster headache (CH) is associated with 'suicidal headache,' but the precise suicidality level remains unclear.
Suicidality is often intuitively linked to CH severity, necessitating empirical investigation.
The PROSPERO-registered systematic review protocol (CRD420251110095) guides this research.

Purpose of the Study:

To systematically review and meta-analyze the rates of suicidal ideation and suicide attempts in CH patients.
To compare suicidality rates between specialized and non-specialized recruitment settings.
To identify psychological and clinical determinants of suicidality in CH.

Main Methods:

Systematic review of PubMed-indexed publications up to July 25.
Meta-analysis of 10 selected studies (34,180 subjects) categorized by recruitment setting.
Qualitative analysis to explore CH suicidality determinants.

Main Results:

Overall suicidal ideation rate in CH: 8.0%; suicide attempts: 1.2%.
Rates in non-specialized settings: ideation 5.2%, attempts 1.1%.
Rates in specialized settings: ideation 44.6%, attempts 5.1%.
Qualitative analysis suggests increased risk during attacks, linked to demoralization and impulsive aggressiveness.

Conclusions:

Overall suicidal risk in CH is not significantly higher than the general population.
CH patients in specialized care show a markedly increased suicidal risk.
This elevated risk is associated with CH severity, pain, and psychological factors like demoralization and impulsivity.