Anxiety, depression, and sexual dysfunction in drug-naive female migraine patients: a case-control study

Background Migraine is a prevalent neurological disorder associated with psychiatric comorbidities including anxiety and depression. However, the impact of migraine on sexual function in women and the mediating role of psychological factors remain poorly characterized, particularly in drug-naive patients. This study aimed to compare anxiety, depression, and sexual function between female migraine patients and healthy controls, and to evaluate the mediating role of psychological comorbidities in migraine-associated sexual dysfunction. Methods This case-control study enrolled 85 drug-naive female migraine patients diagnosed according to ICHD-3 criteria and 116 headache-free female controls from Kırşehir Ahi Evran University Hospital and affiliated primary care family health centers, Türkiye. All participants completed the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Female Sexual Function Index (FSFI). Female sexual dysfunction (FSD) was defined as FSFI score < 26.55. Group comparisons used Mann–Whitney U tests and chi-square tests. Multiple linear regression and bootstrapped mediation analysis assessed the relationships between migraine, depression, and sexual function. Results Migraine patients had significantly higher BAI (23.5 ± 12.5 vs. 12.4 ± 8.9, p < 0.001) and BDI scores (17.4 ± 9.5 vs. 11.2 ± 7.7, p < 0.001), and lower FSFI scores (21.8 ± 5.6 vs. 25.5 ± 4.7, p < 0.001) compared to controls. FSD was present in 76.5% of migraine patients versus 60.3% of controls ( p = 0.024). All six FSFI subdomains were significantly impaired. In multivariate analysis, migraine independently predicted lower FSFI scores (β = −3.40, p < 0.001). Mediation analysis revealed that depression accounted for 34.0% of the total effect (indirect effect = −1.15), while migraine retained a significant direct effect (c′ = −2.24, p = 0.028). No significant differences were detected between chronic ( n = 25) and episodic ( n = 60) migraine subgroups, though this comparison was underpowered. Conclusions Drug-naive female migraine patients exhibit significantly higher rates of anxiety, depression, and sexual dysfunction compared to healthy controls. Depression partially mediates the effect of migraine on sexual function, but migraine also exerts a direct, independent effect. These findings highlight the importance of routine screening for sexual dysfunction and psychological comorbidities in female migraine patients.