Post-Traumatic Headache Linked to Suicide Risk in US Veterans

Key Clinical Summary

• Veterans with post-traumatic headache (PTH) after traumatic brain injury had higher risks of suicidal ideation and suicide attempts than matched veterans with traumatic brain injury without headache.
• In a cohort of more than 95 000 veterans, PTH was associated with a 45% higher risk of suicidal ideation and a 66% higher risk of suicide attempts before adjustment.
• PTH was not independently associated with increased suicide mortality after accounting for clinical and psychiatric factors.

Post-traumatic headache (PTH) is a frequent and challenging sequela of traumatic brain injury among United States veterans, yet its relationship with suicide-related outcomes has been poorly defined. Using Veterans Health Administration (VHA) and Department of Defense (DOD) electronic health record data, investigators conducted a large retrospective cohort study to evaluate whether PTH confers additional suicide risk beyond traumatic brain injury alone.

Study Findings 

The study analyzed data from fiscal years 2008 through 2020 and included 95 224 veterans with traumatic brain injury, half of whom had a diagnosis of PTH. The cohort was predominantly male (90.0%) and White, non-Hispanic (77.2%), with a mean age of 45.9 years.

Among the 47 612 veterans with PTH, 9.7% reported suicidal ideation or suicide attempts, compared with 6.6% of matched controls without headache. Veterans with PTH had a significantly higher unadjusted risk of suicidal ideation (relative risk [RR], 1.45; 95% CI, 1.39–1.51) and suicide attempts (RR, 1.66; 95% CI, 1.50–1.83).

After adjustment using inverse probability of treatment weighting to account for medical and psychiatric comorbidities, the associations remained statistically significant, though attenuated. PTH was associated with a 5% increased risk of suicidal ideation (RR, 1.05; 95% CI, 1.00–1.09) and a 19% increased risk of suicide attempts (RR, 1.19; 95% CI, 1.09–1.30). In contrast, no significant difference in suicide death was observed between groups (RR, 0.83; 95% CI, 0.67–1.02).

The authors noted that veterans with PTH had substantially higher rates of comorbid conditions known to influence suicide risk, including non-headache pain (73.2% vs 42.4%) and post-traumatic stress disorder (48.0% vs 26.7%).

Clinical Implications

For clinicians caring for veterans with traumatic brain injury, these findings highlight PTH as an important marker of elevated suicide-related risk. Although PTH did not independently increase suicide mortality, its association with suicidal ideation and attempts suggests a need for heightened vigilance.

Routine headache management in this population should be integrated with systematic suicide risk screening and evaluation of co-occurring psychiatric and pain-related conditions. The results support multidisciplinary approaches that address chronic pain, mental health comorbidities, and substance use disorders alongside headache treatment.

Given that much of the increased risk persisted even after adjustment, PTH may represent a distinct clinical phenotype warranting targeted prevention strategies. Early identification and ongoing monitoring may help mitigate progression from ideation to attempts, particularly within VHA care settings.

The investigators concluded that “clinicians should be aware of heightened suicide risk among veterans with PTH and be especially diligent in terms of screening for suicide risk and related medical and mental health comorbidities.” They emphasized that while suicide mortality did not differ, the elevated risk of suicidal ideation and attempts underscores the need for targeted suicide prevention efforts within headache and traumatic brain injury care programs.

Conclusion

In this large US veteran cohort, PTH was associated with increased suicidal ideation and suicide attempts but not suicide death. The findings reinforce the importance of comprehensive, integrated care models that combine headache management with proactive suicide risk assessment and prevention strategies for veterans with traumatic brain injury.

Reference

Anthony SE, Phadke MA, Lipton RB, et al. Suicide-related outcomes in veterans with post-traumatic headache: a retrospective cohort study. Lancet Reg Health Am. 2026;53:101299. doi:10.1016/j.lana.2025.101299