Suicidality, Depression, and Anxiety Linked to Tension Headaches

In patients with tension headaches, researchers in South Korea found that the incidences for major depressive disorder, generalized anxiety disorder, and suicidality were higher.

Suicidality was seen in 24.7% of patients with tension-type headaches; furthermore, depression, anxiety, a low education level, insomnia, pericranial tenderness, and chronic tension-type headaches were major risk factors for suicidality in this patient population, according to a study published in the Journal of Clinical Neuroscience.

This multicenter case-controlled study recruited 332 participants from 4 Korean general hospitals. They were matched with an equal number of healthy controls with similar socioeconomic, demographic, and clinical characteristics. Participants were assessed using the Insomnia Severity Index and the Headache Impact Test-6. Participants were also interviewed to identify suicidality, generalized anxiety disorder (GAD), and major depressive disorder (MDD) using the Mini International Neuropsychiatric Interview—Plus Version 5.0.0.

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Of the 332 total participants with tension-type headaches, 56.6% (n=188) had chronic tension headaches and 25.3% (n=84) had pericranial tenderness. The frequency of MDD, GAD, and suicidality was significantly higher in participants with tension headaches (18.4%, 12.7%, and 24.7%, respectively) compared with healthy controls. Suicidality frequency was 2.4 times higher in tension headache patients than in controls. The major risk factors for suicidality were pericranial tenderness (AOR, 2.055; 95% CI, 1.082-3.903; P =.028), chronic tension-type headache (AOR, 2.056; 95% CI, 1.113-3.799; P =.021), insomnia (AOR, 2.092; 95% CI, 1.079-4.053; P =.029), a low education level (AOR, 2.377; 95% CI, 1.251-4.518; P =.008), GAD (AOR, 2.749; 95% CI, 1.142-6.615; P =.024), and MDD (AOR, 5.606; 95% CI, 2.689-11.685; P <.001).

Study limitations included participants coming exclusively from a general hospital population and the cross-sectional study design, which means that between-variable causal relationships could not be confirmed. Although a high risk for suicidality does seem to be present among patients with chronic tension-type headaches, further studies are needed to explore the relationship and confirm the findings.


Seo JG, Kim KT, Moon HJ, Kuk Do J, Kim SY, Park SP. Suicidality and its risk factors in tension-type headache patients: A multicenter case-control study [published online August 29, 2019]. J Clin Neurosci. doi: 10.1016/j.jocn.2019.08.084

This article originally appeared on Neurology Advisor