Depression and anxiety in adults with chronic headache conditions: A systematic review and meta-analysis

Evidence from epidemiological studies suggest that the prevalence of depression and anxiety among adults with chronic headaches is high, however, uncertainties remain about the magnitude of this comorbidity. The current meta-analysis aimed to determine the prevalence of depression and anxiety among adults with chronic headache conditions and identify factors that moderate prevalence. Four databases were searched from 2013 to 2024: CENTRAL, MEDLINE, EMBASE, and PsycINFO. Studies reporting the prevalence or clinical symptoms scores of depression or anxiety among adults with chronic headaches (i.e., headaches > 15 days/month for > 3 months) were included. Prevalence rates among individuals without a headache condition, or with an episodic headache disorder, were extracted separately for comparison purposes. Of the 37,149 initial records identified, 48 studies (N = 9582) met inclusion criteria. Clinical symptoms of depression and anxiety were present in 43.1% (95% CI: 37.8, 48.6; I² = 94.52) and 45.9% (95% CI: 39.1, 52.9; I² = 96.06) of adults with chronic headaches, respectively. Headache condition (p= .006) and location (p= .001) moderated the prevalence of depression but not anxiety. Compared to adults without headaches, adults with chronic headaches were 4.86 times more likely to have clinical symptoms of depression, and 7.06 times more likely to have clinical symptoms of anxiety. Similarly, they were 2.45 and 2.20 times more likely to have clinical symptoms of depression and anxiety, respectively, compared to individuals with episodic headaches. Almost half of adults with chronic headaches experience comorbid depression or anxiety, highlighting the urgent need for better mental health screening and treatment.