Higher lifetime psychiatric diagnoses and suicide attempts in women with migraine: cross-sectional results from a women’s mental health clinic in Australia

There is a strong bidirectional association between psychiatric conditions and migraine, especially in women who are disproportionately affected by such conditions. Though individual associations between psychiatric conditions and migraine are well described, their additive burden at an individual level is under-studied. Among women seeking psychiatric care, we aimed to describe whether women with migraine, when compared to women without migraine, were more likely to accumulate higher lifetime psychiatric diagnoses and suicide attempts. Quantifying this risk at an individual level allows identification of high-risk groups who may benefit from opportunistic and potentially life-saving risk screening. We compared the total numbers and types of lifetime psychiatric diagnoses in women with and without migraine attending a specialist women’s mental health clinic between January 2016 and June 2026. Non-consenting participants were excluded. We specifically targeted this population to allow opportunistic overlay of cross-sectional telephone-based migraine diagnoses conducted by a blinded headache neurologist, against medical, psychiatric and social histories gathered prospectively by a consultant psychiatrist. Comparisons between independent groups, with and without migraine, were compared using binary logistic regression and Pearson Chi Square tests. Of 1435 patients seen during the 11-year study period from 2016-2026, 627 patients consented to the study. Compared to women without migraine, women with migraine more commonly fulfilled diagnostic criteria for major depressive disorder(p<0.001), generalised anxiety disorder(p<0.001), premenstrual dysphoric disorder(p<0.001) and complex post-traumatic stress disorder(p<0.001). Women with migraine reported higher DASS21 scores for depression(p=0.041), anxiety(p=0.014) and stress(p=0.016). The odds of migraine increased by 66% with each accumulating psychiatric diagnosis (OR 1.660, 95% CI: 1.466-1.879, p<0.001) when compared to counterparts without migraine. Women with migraine reported more passive suicidal thoughts (p=0.014) and active suicide attempts (p=0.028) compared to women without migraine. Among women receiving psychiatric care, women with migraine have a higher lifetime burden of psychiatric conditions compared to women without migraine; this is associated with higher depression, anxiety and stress scores, and suicide attempts. Recognition of the additive burden of migraine with mental ill health should lead to opportunistic risk screening which could be a proactive lifesaving strategy for this vulnerable population. We know that women with migraine have a higher risk of mental health disorders - but their additive burden at an individual level is under-studied. Among women receiving psychiatric care, we found that women with migraine, when compared to women without migraine, accumulate more psychiatric diagnoses within a lifetime – especially depression, anxiety, complex post-traumatic stress disorder and premenstrual dysphoric disorder. Women with migraine, when compared to women without migraine seeking psychiatric support, also report more passive suicidal thoughts and suicide attempts so would benefit from more risk screening during clinical encounters.