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
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.