The Impact of Economic Distress on Primary Headache Visits Under the Strain of the COVID-19 Pandemic: A Retrospective Study.

Background and Objectives: Macroeconomic instability, particularly income loss, inflation and unemployment, is increasingly recognized as a psychosocial stressor that may influence both symptom burden and healthcare-seeking behavior. This single-center study investigated the association of income, inflation and unemployment with private-sector hospital visits for primary headache disorders and assessed whether economic stressors were associated with different patterns across demographic groups. Materials and Methods: We conducted a single-center, retrospective, ecological quarterly time-series analysis of hospital visits for primary headache disorders between 2016 and 2024 in a private tertiary care hospital in Turkey. After exclusions, 18,522 eligible hospital-visit records were included and categorized by sex and age (<18, 18-64, and ≥65 years). National data on real gross domestic product (GDP), consumer price index (CPI), unemployment and a COVID-19 period indicator were used. Counts were modeled with log-linked Poisson or negative binomial generalized linear models selected through overdispersion diagnostics, with seasonal controls and HAC-robust inference. Results: In most groups, higher GDP was associated with more primary headache visits, whereas higher inflation was consistently associated with fewer visits. The association with unemployment was heterogeneous: visits decreased significantly among the working-age population but increased among older adults. Contemporaneous models outperformed one-quarter lagged alternatives, suggesting that private-sector healthcare seeking may change within the same quarter as macroeconomic shocks. Conclusions: In this private hospital setting, macroeconomic deterioration was associated with reduced primary headache visits, particularly among working-age patients. These findings suggest that financial constraints may suppress private-sector healthcare utilization despite possible increases in stress-related symptoms, and that private hospital data may underestimate headache-related healthcare need during economic crises.