Psychosocial factors as predictors of headache chronification: A systematic review and meta-analysis of longitudinal...

This study aimed to systematically review the literature and summarize, as well as quantitatively pool when feasible, longitudinal evidence regarding psychosocial predictors of headache chronification.

A comprehensive search was conducted in PubMed/MEDLINE, CINAHL, and PsycInfo. The Domain-Determinants-Outcome framework was used to design the search strategy, and studies were screened according to the Patients Intervention Comparator Outcome Timing Setting framework. Risk of bias was assessed using the Newcastle-Ottawa Scale. A meta-analysis was performed, and the certainty of evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation approach.

The initial search, including two additional studies identified through hand-searching, yielded 1509 studies after removal of duplicates, of which eight met the inclusion criteria. Seven studies focused on depression as a predictor of migraine chronification and one on depression as a predictor of tension-type headache (TTH) chronification. One study examined anxiety and another studied stress as predictors of both migraine and TTH chronification. Five studies were included in the meta-analysis for depression as predictor; the pooled unadjusted risk ratio was 2.26 (95% confidence interval = 1.69-3.02), the adjusted risk ratio was 1.53 (95% confidence interval = 1.47-1.58), and Grades of Recommendation, Assessment, Development, and Evaluation assessment indicated that depression is a significant predictor of migraine chronification, with a moderate certainty of evidence. For anxiety and stress, the certainty of evidence was rated as moderate. Due to limited data, no firm conclusions could be drawn for other psychosocial factors or for predictors of TTH chronification.

There is moderate certainty of evidence supporting depression as a predictor of migraine chronification. For anxiety and stress in relation to migraine and TTH, the certainty of evidence is moderate.