Abstract text (incl. figure legends and references)

Stress is the most significant trigger for many types of headaches. In the las two years people faced two major stressful event: Covid-19 pandemic and the armed conflict between Russia and Ukraine. The purpose of the study was to evaluate the influence of the pandemic and the war on the condition of patients who visit a specialized headache clinic.

Methods. We performed retrospective analysis of medical records of all headache patients ≥16 yo who visited the University Headache Clinic from April 01 to June 30 in 2019, 2021 and 2022 was carried out. The diagnosis of the headache and comorbid mental disorders, was made according to the criteria of ICHD-3 (2018) and ICD-10.

Results. The analysis included 849 people: 153 patients in 2019, 264 in 2021 and 432 in 2022. The migraine and tension type headache (TTH) characteristics did not change in 2021 and 2022 years compared with 2019 year. In 2021, the proportion of patients with generalized anxiety disorder has increased from 28,8% (24 patients) to 44,9% (119 patients), p=0,001. Proportion of patients with anxiety remains high in 2022 (43,6%, 179 patients). Proportion of patients with depression didn"t differ significantly between 2019 (32%, 49 patients) and 2021 (28,7%, 76 patients) , p=0,5. In 2022, the proportion of patients with depression significantly increased from 28,7% (76 patients) to 43,9% (188 patients), p=0,0001, The main symptoms of depression were anhedonia, lack of internal energy, and feeling of guilt. The proportion of patients with a first depressive episode has increased significantly from 2,7% (7 patients) to 21,3% (31 patients), p=0,0001.

Conclusions. Significant stressful events had an impact on comorbid psychiatric disorders in primary headache disorders. Covid-19 pandemic led to increase of comorbid anxiety and the war resulted in significantly increased comorbid depression among Russian headache patients