Generalized anxiety disorder, subthreshold anxiety and anxiety symptoms in primary headache


Correspondence: Giancarlo Lucchetti, MD, Department of Neurology, Federal University of São Paulo, Rua Dona Elisa, 150 apto 153B, Barra Funda, São Paulo, CEP 01155030, Brazil. Email:



The aim of the present study was to evaluate the association between generalized anxiety disorder, subthreshold anxiety (SubAnx) and anxiety symptoms in the prevalence of primary headache.


This cross-sectional study evaluated 383 people from a Brazilian low-income community. One-year prevalence rates of migraine, chronic migraine and tension-type headache were calculated. Anxiety symptoms were then separated into the following groups (based on DSM-IV criteria): no anxiety criteria; one anxiety criterion; two anxiety criteria; and generalized anxiety disorder (GAD). The control group (no headaches) was compared with headache sufferers for each anxiety group using an adjusted model controlled for confounding factors.


GAD was present in 37.0% of participants and SubAnx in 16.6%. Those with SubAnx had a 2.28-fold increased chance of having migraine; 3.83-fold increased chance of having chronic migraine, a 5.94-fold increased chance of having tension-type headache and a 3.27-fold increased chance of having overall headache. Some anxiety criteria (irritability, difficulty with sleep, concentration problems, muscle tension and fatigue) had similar prevalence to International Classification of Headache Disorders (ICHD-II) headache criteria such as unilateral pain and nausea for migraine and chronic migraine.


Headache sufferers seem to have a high prevalence of anxiety symptoms and SubAnx. In addition, the presence of two or more anxiety criteria (not necessarily fulfilling all the criteria for GAD) was associated with having a headache disorder.