Title : Factors influencing delayed diagnosis in pediatric brain tumors with pre-diagnostic symptomatic interval and initial symptoms: A systematic review
Abstract:
Introduction: Migraine is a chronic neurological disorder affecting more than 10% of the global population and is a leading cause of years lived with disability, particularly among young women. Major depressive disorder (MDD) is one of the most prevalent psychiatric conditions worldwide and frequently coexists with chronic illnesses. Growing evidence suggests a significant association between migraine and depression, potentially driven by shared neurobiological pathways and the disabling nature of recurrent headaches. This systematic review evaluates the global prevalence of depression among adults with migraine and identifies associated risk factors.
Methods: A systematic review of peer-reviewed observational studies published between 2016 and 2026 was conducted. Eligible studies included cross-sectional, cohort, and case-control designs evaluating depression prevalence among adults diagnosed with migraine according to established criteria such as the International Classification of Headache Disorders (ICHD-III). Depression was assessed using validated screening tools, including the Patient Health Questionnaire-9 (PHQ-9) and the Zung Self-Rating Depression Scale (SDS). Ten international studies from Israel, Saudi Arabia, China, South Korea, the United States, Spain, Brazil, Ethiopia, and Australia were included, representing more than 417,000 participants.
Results: Across the included studies, the prevalence of depression among individuals with migraine ranged from 12.7% to 41.4%. Population-based data from Israel reported depression in 18.6% of migraine patients, while studies from Spain and China documented prevalence rates of 26.3% and 25.9%, respectively. Higher estimates were observed in certain populations, including 41.4% in Ethiopia and nearly 50% when mild depressive symptoms were included in a Saudi Arabian cohort. Consistent risk factors included female sex, younger age (20–44 years), lower educational attainment, unemployment, higher migraine frequency or severity, and comorbid conditions such as anxiety and insomnia. Migraine-related disability was also significantly associated with depressive symptoms.
Conclusion: Depression affects a substantial proportion of adults with migraine globally, with reported prevalence ranging from approximately 12% to over 40%. The evidence consistently demonstrates that women, younger adults, and individuals experiencing greater migraine severity or socioeconomic disadvantage are at particularly increased risk. These findings underscore the need for routine depression screening in migraine patients and support integrated care strategies addressing both neurological and mental health components to reduce disability and improve patient outcomes.
