Mediation analysis of anxiety and depression between alexithymia and frequency of headache attacks and impact on suicidal ideation in primary headache

Objective: Considering the constellation of psychopathological symptoms that characterize primary headaches, the present study aimed to describe the relationship between specific psychopathological symptoms (i.e., anxiety, depression, and suicidal ideation), psychological variables (i.e., alexithymia), and their impact on headache frequency. Methods: Socio-demographic data (gender, age, occupation, marital status, and educational level) and psychological variables (alexithymia, anxiety, depression, and suicidal ideation) of 70 people with headache (the experimental group was composed of 33 with migraine, 23 with tension-type headache, and 14 with mixed tension migraine) were compared to those of 62 age-matched control subjects. First, participants underwent a neurological examination to make the diagnosis and define the frequency of headache attacks in a month. Consequently, all participants completed the Toronto Alexithymia Scale-20, the Symptom Questionnaire, and the Symptom Checklist 90-Revised. Results: The Headache group reported significantly higher levels of alexithymia, anxiety, depression, and suicidal ideation compared to controls. The mediation analysis, conducted within the patient group alone, proved that anxiety and depression fully mediated the relationship between alexithymia and monthly headache frequency, even controlling for gender and age. Additionally, the frequency of headache attacks predicted suicidal ideation. Discussions: Our results highlight the importance of conducting a psychological evaluation in headache patients because some factors can increase the clinical manifestations of the disease.