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

Background 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. Methods 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. Results 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). Conclusion 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.