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Background:  Psychiatric comorbidity is common among migraineurs, such as anxiety and depression. This type of comorbidity contributed to migraine chronicity, management efficacy, and increasing the risk for other comorbidities. This study designed to estimate the prevalence of depression, anxiety, and stress (DAS) symptoms among Saudi migraine patients using the validated instrument (DASS-21) and considering socio-demographic factors and individual differences that affect migraine progression and prognosis. Design/methods:  Cross-sectional, self-administered, web-based-questionnaire distributed among Saudi Arabia general population. Only migraine patients with clinical diagnosis allowed to complete the survey. Results:  A total of 247 migraine patients participated and they are predominantly females, with ages between 16 and 45 years, Saudi nationals, married, non-smokers but do not exercise regularly. About 73.3% met the abnormal score in anxiety on DASS-21, as well as 70.9% in depression and 72.3% in stress. Four statistically significant correlations with DAS were identified. Migraine patients who are smoking have a higher prevalence of depression and stress ( p  &lt; 0.05). Those who do not exercise regularly have a higher prevalence only for depression ( p  = 0.03). A higher prevalence of all emotional states was found in patients with more than one co-morbidity and patients with a clinical diagnosis of depression and anxiety disorders ( p  &lt; 0.02). The sensitivity of DASS-21 for depression and anxiety are 96.9% and 93.3%, respectively. Conclusions:  Both smoking cessation and exercise to prevent migraine attacks deserve a clinical trial. A holistic approach is needed to decrease psychiatry-related disability and promote management outcomes in migraineurs. Using DASS-21 for migraine patients as a routine screening instrument is valuable to prevent psychiatric comorbidity.

Depression, anxiety and stress in Saudi migraine patients using DASS-21: local population-based cross-sectional survey