Methodological limitations of anxiety screening tools used in migraine studies -a narrative review

BackgroundAnxiety is commonly reported among patients with migraine, and anxiety questionnaires are frequently used to assess anxiety symptoms. This narrative review examines how common anxiety screening tools are applied in migraine studies and whether they are applied and interpreted appropriately.MethodA PubMed search included studies using the Hospital Anxiety Depression Scale (HADS), Generalized Anxiety Disorder 7-Items (GAD-7) or Beck Anxiety Inventory (BAI). The search also included studies using the Hamilton Anxiety Rating Scale (HAM-A) or State Anxiety Inventory (STAI). Eligible patients were diagnosed with migraine according to the International Classification of Headache Disorders (ICHD-2 or ICHD-3).ResultsNinety-eight studies met the inclusion criteria. In 42 studies (41%), an anxiety score above the cut-off was interpreted as an anxiety diagnosis. This approach was used in 52%, 44%, 41%, 29% and 38% of studies using HADS-A, GAD-7, BAI, HAM-A and STAI. Only three studies confirmed the diagnosis through a structured clinical interview. Data presentation and interpretation across the studies were heterogeneous. Only a few of the scales are validated in a population of migraine patients.ConclusionThis study shows that anxiety screening tools are commonly used in migraine studies but with considerable variation in cut-off scores and interpretation. Such methodological differences and limited validation of these tools may make it difficult to determine the true prevalence of anxiety in migraine studies. Further studies are needed to validate these instruments and to establish clear guidelines for their use in migraine research.