Assessment of the Impact of Social Anxiety on Primary Headache in Adolescents: A Case-Control Study

Primary headaches are common in adolescence and frequently associated with psychosocial difficulties. This study investigated the association between social anxiety symptoms and primary headache in adolescents using a case-control design and examined the influence of sociodemographic and environmental factors.

Adolescents aged 12-18 years diagnosed with primary headache according to the International Classification of Headache Disorders, 3rd edition, and age- and sex-matched healthy controls without recurrent headache or psychiatric disease were included. Social anxiety was assessed using the Social Anxiety Scale for Adolescents (SAS-A) and its subscales as follows: Fear of Negative Evaluation, Social Avoidance and Distress-General, and Social Avoidance and Distress in New Situations. Sociodemographic characteristics, parental education, family income, and exposure to secondhand and thirdhand tobacco smoke were recorded.

The study included 190 adolescents (95 with primary headache and 95 controls). Median total SAS-A scores were significantly higher in the headache group than in controls (40 [interquartile range: 31-51] vs 30 [interquartile range: 25-37], P < 0.001). All SAS-A subscale scores were also significantly elevated in adolescents with primary headache (all P < 0.001). Although lower parental education, lower income, and greater tobacco smoke exposure were more common in the headache group, higher social anxiety scores persisted across nearly all sociodemographic subgroups.

Adolescents with primary headache exhibit significantly higher social anxiety levels than healthy peers, independent of socioeconomic and environmental factors. These findings underscore the importance of routine anxiety screening and psychosocial interventions in adolescent headache management.