Chronic Headaches Linked to Rising Youth Anxiety

A new study comparing headache characteristics and anxiety and depression symptoms among children with headache disorders reveals trends in pediatric mental health that warrant further examination.

The study, led by researchers from Cincinnati Children's, analyzed clinical data collected from patients seen in the hospital's multidisciplinary Headache Center. The results show that headache frequency and severity, along with headache-related disability, remained stable from 2006-2022.

However, the percentage of children and adolescents saying they felt anxious or depressed increased significantly during this same time period. This finding appears to be consistent with nationwide trends in youth mental health.

These findings raise important questions about what's causing this upward trend in mental health symptoms—and how clinicians can address it.

A Closer Look at a Possible Correlation

Maya Marzouk, PhD, a National Institutes of Health T32 postdoctoral research fellow in pediatric psychology, has a special interest in how migraines affect children and teens.

"One of my first projects after I joined Cincinnati Children's in 2022 expanded on some initial analyses conducted by a medical student working with neurologist Marielle Kabbouche Samaha, MD. The student's project sought to compare mental health symptoms reported by patients in the headache center in 2010 and 2022," says Marzouk.

"More kids said they had anxiety and depression symptoms in 2022, a trend that has been reported in studies examining the effects of the COVID-19 pandemic on youth. But I wanted to take the research a step further and investigate both mental health and headache patterns." 

Previous studies dating back to the 1980s suggest a link between migraines and mental health difficulties such as anxiety and depression. However, Marzouk and other researchers and practitioners in headache medicine have long questioned whether this connection is causal or even specifically related to headache.

As someone interested in examining these longitudinal trends, Marzouk found herself in the right place at the right time. Not only does the headache center have clinical data she can examine, but the data goes back 16 years.

Working with a Cincinnati Children's statistician, Marzouk examined specific data points to analyze longitudinal trends. These included headache frequency, severity and previous diagnoses of anxiety or depression, among others.

Stable Headache Characteristics

As Marzouk expected, the data analysis confirmed a statistically significant increase in the number of patients with feelings of anxiety and depression from 2006 to 2022.

During that period, the percentage of patients reporting feelings of anxiety more than doubled. This upward trend seems to begin in 2009; in 2022, nearly one out of two patients endorsed feeling anxious.

Similarly, the percentage of patients reporting feelings of depression showed a notable increase in 2019—followed by a return to baseline in 2020, and then a jump over the next two years. In 2022, one out of four patients endorsed feeling depressed.

"I was surprised to find there wasn't a matching increase in migraine disability scores," Marzouk says. "During the same 15-year time frame, as patients began experiencing more anxiety and depression symptoms, their headache characteristics remained remarkably stable." 

Marzouk presented the study results at the American Headache Society's 65th Annual Scientific Meeting in June 2023.

How Providers Can Help

Marzouk says that their data suggest children with feelings of anxiety or depression may not be more prone to higher headache disability relative to youth who do not endorse anxiety or depression symptoms. However, some questions remain unanswered: What new or changing factors are causing this spike in mental health symptoms among children and adolescents?

"The data shows that the number of kids with feelings of anxiety and depression started increasing in 2009 and 2019, respectively," Marzouk says. "This suggests there are factors unrelated to the COVID-19 pandemic influencing mental health."

Marzouk is taking her research further to identify early interventions and holistic treatment for patients with headache and anxiety or depression. For now, she says, one takeaway of her 2023 study is that children and teens are experiencing mental health symptoms in addition to managing headaches or other medical conditions. She encourages healthcare providers to ensure there is a plan for what to do if a patient reports feeling anxious or depressed. Referrals to a behavioral health professional may improve care.

(Published December 2024)

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