Depression, Stress Symptoms, and Cortisol Awakening Response in Female Adolescents with Chronic Headache

Background: Chronic headache in children and adolescents is frequent and often associated with anxiety and depression. Objective: The present study investigated whether anxiety and depression are more pronounced in female adolescents with chronic headache than in those who do not have headaches and explored the role of stress symptoms and stress coping. Method: The sample consisted of 77 fifteen-year-old female adolescents with chronic headache and 72 girls who served as controls. Stress symptoms and stress coping were measured with the Stressverarbeitungsfragebogen für Kinder und Jugendliche (Coping with Stress Questionnaire for Children and Adolescents), depression was assessed by the Depression Inventory for Children and Adolescents, and anxiety was measured by the State- Trait-Anxiety-Inventory for children. The cortisol awakening response was measured as a biological marker of stress. Results: Higher levels of depression as well as anxiety in the adolescents with chronic headache were found. The adolescents with headache showed more stress symptoms and at the same time were limited in their ability to cope with stress. They had also higher cortisol after awakening. Conclusion: Anxiety and depression may contribute to the occurrence and maintenance of headache in adolescents and interfere with adequate coping that would be necessary to overcome chronic stress, as indicated by cortisol.