Depression and anxiety in relation to headache- related disability: A cross-sectional subanalysis of the Philippine Neurological Association One Database (PNA1DB)

Abstract

Background & Objective: Headache disorders are a leading cause of disability. Beyond attack frequency and intensity, psychological distress may contribute to functional impairment, but data from Filipino populations are limited. The objective of this study is to determine whether depression and anxiety are independently associated with headache-related disability as measured by the Migraine Disability Assessment (MIDAS) in a Filipino clinical cohort; to describe levels of disability and psychological distress; and to examine subgroup differences across selected sociodemographic and clinical characteristics.

Methods: We conducted a cross-sectional secondary analysis of de-identified adult records from the Philippine Neurological Association One Database–Headache (PNA1DB– Headache) from June 1, 2021 to June 30, 2025. Primary headache cases with complete MIDAS, depression, and anxiety data were included. Demographic and clinical characteristics were summarized descriptively. Because MIDAS scores were non-normally distributed, associations between MIDAS and mood scores were examined using Spearman’s rank correlation. Group differences in MIDAS were assessed using Mann–Whitney U and Kruskal–Wallis tests with Dunn–Holm post hoc comparisons. Multivariable linear regression with robust standard errors was used to identify independent predictors of disability, adjusting for age, sex, headache phenotype, monthly headache days, headache severity, and prophylactic medication use.

Results: Of 1,100 registry records, 527 primary headache cases met inclusion criteria. MIDAS grades were: little/no disability 52.4%, mild 21.8%, moderate 13.5%, and severe 12.3%. Mean depression and anxiety scores were 4.6 ± 4.0 and 5.6 ± 4.6, respectively. MIDAS correlated positively with depression (ρ = 0.488, p < .001) and anxiety (ρ = 0.475, p < .001). In multivariable regression, depression (B = 0.691, p < .001) and anxiety (B = 0.386, p = .031) were independently associated with higher MIDAS scores. Compared with migraine with aura, migraine without aura and unspecified primary headache were associated with greater disability, while monthly headache days, sex, and prophylactic medication use were not independently significant.

Conclusions: In this registry-based cohort, both depressive and anxiety symptoms were independently associated with greater headache-related disability, with depression demonstrating the stronger effect. These findings support integrating routine mood screening and biopsychosocial management into standard headache care in the Philippines.