Clinical profile of headache attributed to anxiety and depressive disorders: an observational study

Headache attributed to anxiety or depressive disorders was added to the appendix of the International Classification of Headache Disorders, 3rd edition (ICHD-3) in 2018. However, its specific clinical features have not yet been systematically characterized, limiting its early recognition and optimal clinical management.

We conducted an observational study between March 2024 and June 2025 at a headache center in China. Following stringent exclusion of primary headache disorders and other secondary headache causes, 101 patients meeting diagnostic criteria for headache attributed to anxiety and depressive disorders (HA-ADD) were enrolled. Demographic data, detailed headache characteristics, and psychiatric symptoms were collected through structured face-to-face interviews.

The cohort was predominantly female (70.3%; n = 71) with a median age of 36 years. The characteristic HA-ADD phenotype was defined by: (1) pain characteristics: bilateral pain (72.3%) with dull quality (92.1%) and moderate-to-severe intensity (53.5% moderate; 42.6% severe); (2) location: temporal (47.5%) and parietal regions (35.6%); (3) temporal pattern: 60.4% of attacks lasted less than 4 h; (4) associated symptoms: phonophobia (79.2%), restlessness/agitation (58.4%), dizziness (57.4%), and nausea (51.5%); (5) trigger factors: emotional fluctuations (71.3%) and poor sleep quality (57.4%) were predominant. Notably, 73.2% of patients experienced severe headache-related functional impairment (HIT-6 score >60).

Headache attributed to anxiety and depressive disorders presents a distinct clinical profile characterized by bilateral, dull, moderate-to-severe pain with short attack duration and prominent associated symptoms including phonophobia and restlessness. This phenotypic signature differentiates HA-ADD from common primary headache disorders and provides clinical markers that may facilitate earlier diagnosis and appropriate therapeutic intervention.