263: Depression and Anxiety as Predictors of Headache-Related Disability in the Philippines: PNA1DB study

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary headache, Psychology, Assessment and Measurement of Pain/Nociception, Epidemiology

Background and Aims: Headache disorders cause major disability worldwide and are often underrecognized in low- and high-resource settings. In the Philippines, many patients self-medicate and rarely undergo structured disability or mental health assessment. MIDAS quantifies functional impairment, yet attack frequency and pain severity do not fully explain disability. Depression and anxiety commonly co-occur with primary headaches and may worsen disability and chronification. Filipino data on these psychological predictors remain limited. Using the Philippine Neurological Association One Database (PNA1DB), we aim to describe MIDAS disability and depression/anxiety levels, test associations with MIDAS, and identify demographic and clinical factors influencing these relationships in practice.

Methods: We performed a cross-sectional secondary analysis of de-identified adult records from the Philippine Neurological Association One Database–Headache (PNA1DB–Headache) dated June 1, 2021–June 30, 2025. Included were primary headache cases with complete MIDAS, depression, and anxiety data. Demographic and clinical variables were summarized descriptively. Because MIDAS was non-normally distributed, associations with depression and anxiety were tested using Spearman rank correlation. MIDAS differences across subgroups were assessed using Mann–Whitney U or Kruskal–Wallis with Dunn–Holm post hoc tests. Independent predictors were evaluated via multivariable linear regression with robust standard errors adjusting for age, sex, baseline phenotype, monthly headache days, severity, and prophylaxis use.

Results: 527 primary headache cases met inclusion criteria. MIDAS grades were: little/no disability 52.4%, mild 21.8%, moderate 13.5%, and severe 12.3%. Mean depression and anxiety scores were 4.6 ± 4.0 and 5.6 ± 4.6, respectively. MIDAS correlated positively with depression (ρ = 0.488, p < .001) and anxiety (ρ = 0.475, p < .001). In multivariable regression, depression (B = 0.691, p < .001) and anxiety (B = 0.386, p = .031) independently predicted higher MIDAS scores. Compared with migraine with aura, migraine without aura and unspecified primary headache were associated with greater disability, while monthly headache days, sex, and prophylaxis use were not independently significant.

Conclusions: In this cross-sectional analysis of Filipino patients with primary headache disorders, psychological distress was independently associated with greater functional impairment on the Migraine Disability Assessment (MIDAS). Depressive and anxiety symptoms predicted higher disability after adjustment, with depression showing the stronger effect. Migraine without aura and unspecified primary headache were more disabling than migraine with aura, while monthly headache days and other covariates were not significant. These results support a biopsychosocial view of headache burden and highlight integrating routine screening and early management of depression and anxiety into headache care in the Philippines. Longitudinal studies should test causality and treatment benefit.

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Presenting Author: Keanne Paula H. Amamanglon, MD
Submitting Author: Keanne Paula Amamanglon

Senior Author: Keanne Paula H. Amamanglon, MD

IASP 2026 Global Year theme of Neuropathic Pain: No

• Rogie Marie A. Ignacio - Alcantara: MD - Makati Medical Center