healthmedicinet

Research article

Brit A Blaauw, Grete Dyb, Knut Hagen, Turid L Holmen, Mattias Linde, Tore Wentzel-Larsen and John-Anker Zwart

Abstract (provisional)

Background

The comorbidity of headache and psychiatric symptoms is a well-recognized clinical
phenomenon, but there are only limited data regarding the temporal relationship between
headache and symptoms of anxiety and depression as well as behavioral problems in
adolescents. This study investigates the relationship of anxiety and depressive symptoms
and behavioral problems at baseline with recurrent headache at follow-up four years
later.

Methods

Within the Nord-Tr[latin small letter o with stroke]ndelag Health Study (HUNT), including
repeated population-based studies conducted in Norway, 2399 adolescents in junior
high schools aged 12-16 years (77% of the invited) participated in Young-HUNT1 (1995-1997)
and again at follow-up four years later, in Young-HUNT2 (2000-2001). The same comprehensive
questionnaire that included assessment of symptoms of anxiety and depression and behavioral
problems, i.e. conduct and attention difficulties was completed in both studies. In
addition 1665 of the participants were interviewed about their headache complaints
in Young-HUNT2.

Results

In adjusted multivariate analyses we found that higher scores of anxiety and depressive
symptoms at baseline were associated with recurrent headache at follow-up four years
later (OR: 1.6, 95%CI: 1.2-2.1, p = 0.001), evident for migraine (OR: 1.8, 95%CI:
1.2-2.7, p = 0.008) and non-classifiable headache (OR: 1.7, 95%CI: 1.0-2.8, p = 0.034),
but not statistically significant for tension-type headache (OR: 1.4, 95%CI: 1.0-1.9,
p = 0.053). Higher scores of anxiety and depressive symptoms at baseline were significantly
associated with more frequent headache at follow-up (monthly vs. no recurrent headache
OR: 1.8, 95%CI: 1.3-2.5, p = 0.001, weekly or daily vs. no recurrent headache OR:
1.9, 95%CI: 1.2-2.9, p = 0.005). Among adolescents without recurrent headache at baseline,
higher scores for symptoms of anxiety and depression were associated with new onset
migraine four years later (OR: 2.6, 95%CI: 1.1-4.8, p = 0.036). Higher scores of attention
problems at baseline were associated with non-classifiable headache at follow-up (OR:
2.0, 95%CI: 1.3-3.4, p = 0.017).

Conclusions

Results from the present study showed that symptoms of anxiety and depression in early
adolescence were associated with recurrent headache four years later. Recognizing
anxiety and depressive symptoms should be considered part of the clinical assessment
in young headache patients, as early identification of these associated factors may
lead to improved headache management.