Anxiety, depression, and headache-related disability in a large pediatric clinic-based sample

Christina Murphy; Ali Ladak; Christina L Szperka; Blanca Marquez De Prado; Andrew D Hershey; Carlyn Patterson Gentile

doi:10.1111/head.14849

Anxiety, depression, and headache-related disability in a large pediatric clinic-based sample

Headache. 2024 Nov 15. doi: 10.1111/head.14849. Online ahead of print.

Authors

Christina Murphy^{1

2}, Ali Ladak¹, Christina L Szperka^{1

2}, Blanca Marquez De Prado¹, Andrew D Hershey³, Carlyn Patterson Gentile^{1

2}

Affiliations

¹ Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
² Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ Departments of Pediatrics and Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

PMID: 39545632
DOI: 10.1111/head.14849

Abstract

Objective: To explore the relationships among anxiety, depression, and headache-related disability in a pediatric clinic-based retrospective cross-sectional study.

Background: Anxiety and depression are commonly considered comorbidities of headache disorders and are frequently seen in children and adolescents. These conditions can contribute to disability and may have a cumulative impact. In this study, we tested whether self-reported anxiety and/or depression in youth were associated with headache-related disability.

Methods: This was a retrospective cross-sectional study of children ages 6-17 years old who completed a headache intake questionnaire at the time of a new outpatient neurology visit. Those who reported on behavioral health symptoms, involvement of a behavioral health provider (i.e., yes/no), and the PedMIDAS (a validated metric of headache-related disability) were included. The relationship between anxiety and/or depression and headache-related disability was examined.

Results: Of the 12,660 questionnaires queried, 9118 met criteria for inclusion. Respondents were 64.0% female and had a median age of 13.5 years (interquartile range [IQR] 10.3, 15.7). Compared to patients without self-reported anxiety/depression, patients with anxiety and depression reported higher headache-related disability (M = 17.0, [IQR 6.0, 41.0]) even after accounting for covariates (estimated difference = 6.0, 95% confidence interval [CI: 4.4-7.5]). For participants with anxiety and/or depression, having a behavioral health provider was associated with greater headache-related disability (estimated difference = 7.0; 95% CI 4.6-9.3).

Conclusions: Patients with self-reported anxiety and/or depression reported higher headache-related disability. Having a behavioral health provider was associated with greater headache-related disability, indicating the complexity and high level of need for this population. Further research is needed to understand the directionality of these results; however, patients with headache as well as depression and or anxiety are a vulnerable group who may benefit from an integrated care model.

Keywords: anxiety; depression; headache; pediatric.

Abstract

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