Headache and Psychological Comorbidities: An Appraisal of the Evidence

Background: It has been observed that there is a higher-than-expected risk of anxiety and depression in children with chronic headache and also an increased risk for the persistence of headache in patients with anxiety and depression. Objectives: This review aims to identify and assess the relationships between primary headache disorders and comorbid emotional and psychological disorders. Methods: A targeted review of the literature was carried out. Results: The associations between the disorders are more pronounced in clinic patients, who may represent the severe end of the headache spectrum, but less clear in patients who were identified in population-based studies and who may represent the “average” child with headache or the “average” child with psychological disorders. Conclusions: Understanding this bidirectional association of comorbid disorders is of great importance to offering a holistic biopsychosocial approach to the management of headache disorders in children and adolescents and in addressing the risks for and the co-existence of psychological comorbidities.