Headaches were overlooked in treatment during the coronavirus "COVID-19" pandemic. This study aimed to assess the impact of COVID-19 on patients with tension headache (TH) and identify predictors of headache worsening.

This cross-sectional study compared TH patients (PwTH) (n=157) to controls without TH (PwoTH) (n=151) during the pandemic. Sociodemographic, clinical, COVID-19-related, depression, and anxiety data were contrasted between groups pre-pandemic and during-pandemic. PwTH was categorized into worsening (WPwTH) and non-worsening (NWPwTH) groups to identify worsening predictors.

66.2% of PwTH were females versus 49.7% of PwoTH (p=0.004). Both groups exhibited significantly increased depression and anxiety levels during versus pre-pandemic, with no intergroup differences. Of 157 PwTH, 125 (79.6%) had WPwTH versus 32 (20.4%) had NWPwTH during pandemic. WPWTH had significantly increased headache frequency versus NWPwTH during the pandemic (P=0.001). Both subgroups had increased anxiety and depression, but WPWTH had significantly higher increase in anxiety (P=0.03). Regression analysis revealed that family COVID-19 exposure, healthcare visits, and increased anxiety significantly predicted TTH worsening.

This study revealed that a substantial percentage of TTH patients worsened during the COVID-19 pandemic. Family COVID-19 exposure, healthcare visits, and increased anxiety predicted worsening TTH. Managing these factors during stress may avoid TTH worsening.