The Journal of Headache and Pain

"European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

The Journal of Headache and Pain Cover Image
Open Access

The importance of anxiety and depression as factors in chronicization of primary headaches

  • Rosanna Cerbo,
  • Maria Pia Prudenzano,
  • Piero Barbanti,
  • Mariantonietta Savarese,
  • Virgilio Gallai,
  • Andrea Albert,
  • Maria Nicolodi,
  • Stefania Canova,
  • Gennaro Bussone,
  • Domenico D'Amico,
  • Giuseppe Libro,
  • Licia Grazzi,
  • Franco Granella,
  • Giorgio Zanchin,
  • Giorgio Sandrini,
  • Anna Pia Verri,
  • Giorgio Nider and
  • Giuliano Relja
The Journal of Headache and PainOfficial Journal of the Italian Society for the Study of Headaches1:0001S045.10194


A multicenter study was carried out in 10 Italian headache centers to investigate the prevalence of anxiety and depression in patients with chronic daily headache(CDH). The study investigated 219 patients (171 F; 48 M) including 53 cases of chronic tension-type headache (CTTH), 99 cases of CTTH+ migraine and 67 cases of transformed migraine (TM). The type of headache diagnosed at the beginning was episodic tension-type headache (ETTH, n=32), ETTH + migraine (n=2), CDH ab initio (n=22), migraine with/without aura (n=151), not classifiable migraine (n=7) and not classifiable headache (n=3). The assessment of anxiety and depression was carried out using a Zung self-rating scale for anxiety (Zung A) and for depression (Zung D). The results show that anxiety and depression levels, in each group, were related to sex (F>M). Anxiety, but not depression, was related to the length of chronicization process. Anxiety and depression did not correlate with type of headache at onset, with ongoing headache or, surprisingly, with the abuse of anti-inflammatory drugs. These data suggest the chronicization is a biological and psychological trait.

Key words Chronic daily headacheAnxietyDepressionOveruse of analgesicsZung scale