Is the psychiatric symptom burden higher in individuals with post-earthquake tension-type headache?

Aims: To evaluate post-traumatic stress and anxiety symptom levels in patients with post-earthquake tension-type headache (TTH) and to examine their association with headache severity.Methods: This prospective case-control study included 101 patients with new-onset chronic TTH following the February 6, 2023, Kahramanmaraş earthquakes and 102 healthy controls. Headache severity was assessed using the visual analog scale (VAS), post-traumatic stress symptoms with the PCL-5, and anxiety levels with the Beck Anxiety Inventory (BAI).Results: Female representation was significantly higher in the TTH group compared with controls (77.2% vs. 54.9%, p=0.001). Post-earthquake VAS scores were significantly higher than retrospectively recalled pre-earthquake scores (7.0 vs. 4.0, p=0.001). PCL-5 scores did not differ significantly between groups (p=0.349), and the proportion meeting the ≥31 cutoff for probable PTSD was similar (55.4% [56/101] vs. 57.6% [57/99], p=0.754). In contrast, Severe anxiety was more frequent in patients with TTH than in controls (17.8% vs. 7.8%, p=0.017). In multivariable logistic regression analysis, elementary education (OR: 4.23, 95% CI: 1.61–11.16, p=0.004), In multivariable logistic regression analysis, elementary education (OR: 4.23, 95% CI: 1.61-11.16, p=0.004) and residence in the central study region were independently associated with the outcome. (OR: 2.76, 95% CI: 1.45-5.26, p=0.002), severe anxiety (OR: 5.24, 95% CI: 1.64-16.73, p=0.005), and younger age (OR: 0.95, 95% CI: 0.92-0.98, p=0.003) were independently associated with higher odds of belonging to the post-earthquake TTH group. Conclusion: This study revealed a differential pattern of psychiatric symptom burden in post-earthquake TTH: while PTSD symptoms were similarly elevated in both patients and controls exposed to the same earthquake, anxiety-particularly severe anxiety-showed a specific association with TTH status and headache intensity. These findings suggest that post-earthquake TTH may benefit from multidisciplinary biopsychosocial care multidisciplinary biopsychosocial care with particular attention to anxiety management.