The original Epidemiological Catchment Area (ECA) study (based on interviews conducted in the 1980s) exam- ined the prevalence of mental disorders among adults in five American cities. Taking a fresh look, researchers examined data from 6,832 adults who resided in the community in order to ascertain the rela- tionship between headache and suicidali- ty. Participants completed an interview that assessed both mental health and somatic symptoms. Between a year and two years after this assessment, partici- pants completed a follow-up interview. The presence of severe headache at base- line was associated with increases of 47% to 82% in various forms of suicidality, including wanting to die, contemplating suicide, and making a suicide attempt. Even when controlling for the presence of depression, anxiety, and drug/alcohol abuse and dependence, people who expe- rienced severe headaches were significant- ly more likely to report some form of sui- cidality at the follow-up interview (Woolley SB et al., J Nerv Ment Dis 2008;196:822-828).

TCPR’s Take: The assessment of headache in the interview was inexact. People were designated as having “severe headache” if they endorsed that they had “ever had a lot of trouble with headaches.” Thus, it is unclear what type, frequency, or intensity of headache places people at highest risk for increased suici- dality. Nonetheless, results from another large epidemiological dataset using very similar methods also linked headache to suicidality (Ilgen MA et al., Gen Hosp Psychiatry 2008;30:521-527). Clinicians should assess for suicidal thoughts and behaviors in patients experiencing diffi- culties with headache.