Objective The present study aimed to explore the relationship between the COVID‐19 pandemic and headache‐related disability among a sample of young adults with migraine. Background Comorbid psychological symptoms compound migraine‐related disability. Due to COVID‐19 pandemic procedures, many students experienced institutional closures and corresponding increases in depression, stress, and anxiety. The present study sought to examine changes in headache‐related disability before (Spring and Fall of 2019) and during (Fall of 2020 and Spring 2021) the COVID‐19 pandemic and whether psychological symptoms mediated such changes. Methods A cross‐sectional study at a southern U.S. university assessed 365 individuals with migraine on headache and psychological variables, comparing those surveyed before COVID‐19 with another group surveyed during the pandemic. The direct and indirect effects of COVID‐19 status (pre‐ versus during COVID‐19) on headache‐related disability through depression, anxiety, and stress symptoms were assessed. Results Statistically higher levels of depression, (M = 13.9 [SD = 12.2] vs. M = 8.7 [SD = 8.7], p < 0.001), anxiety (12.3 [10.0] vs. 9.7 [8.2], p = 0.01), and stress symptoms (17.6 [10.2] vs. 13.2 [7.9], p < 0.001) were endorsed during the COVID‐19 pandemic. The direct path from COVID‐19 status to headache‐related disability was significant and negative, c′ = −1.6 (95% CI: −3.1, −0.1). Anxiety (b = 0.3 [95% CI: 0.01, 0.9]) and depression (b = 0.7 [95% CI: 0.07, 1.4]) symptoms acted as mediators of this relationship, rendering the total effect nonsignificant and negating the lowered disability observed during the pandemic. Only depression symptoms remained a significant mediator after controlling for headache frequency (b = 0.7 [95% CI: 0.09, 1.4]). Conclusions Increased depression and anxiety symptoms attenuated the improvements in disability associated with the pandemic. As such, interventions that address comorbid psychological symptoms may hold value in reducing headache‐related disability and improving outcomes for young adults whose headache developed or worsened during the COVID‐19 pandemic.
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