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

Background Headache attributed to anxiety or depressive disorder was added to the appendix of the International Classification of Headache Disorders, 3rd edition (ICHD-3) in 2018. However, the clinical features have not been systematically characterized. This study aims to describe its clinical profile of headache attributed to anxiety and depressive disorders (HA-ADD). Methods An observational study was performed between March 2024 and June 2025 in a Chinese headache center. A total of 101 patients diagnosed with HA-ADD were enrolled after excluding primary headaches and other secondary causes. Clinical data were collected through structured face-to-face interviews. Results Headache experienced by majority of the participants was bilateral (72.3%), dull type (92.1%) and of moderate-to-severe intensity (96.1%). The most frequently locations of headache were the temporal (47.5%), parietal (35.6%) regions. 60.4% of attacks lasted for less than 4h. Common accompanying symptoms were phonophobia (79.2%), restlessness and agitation (58.4%), dizziness (57.4%), and nausea (51.5%). Emotional fluctuations (71.3%), poor sleep (57.4%) were the most common triggering factors. 73.2% of patients reported severe headache impact on daily life. Conclusions Headache attributed to anxiety and depressive disorders has distinct clinical characteristics that may aid in its early clinical recognition.