Anxiety and the severity of Tension-Type Headache mediate the relation between headache presenteeism and workers' productivity.

The primary objective of this study was to explore the mechanisms and conditions whereby Tension-Type Headache (TTH) presenteeism relates to health-related loss of productivity as a result of both reduced physical and mental health. To this end, Structural Equation Modeling (SEM) was used to conduct a secondary data analysis of a randomized clinical trial involving 78 Tension-type Headache (TTH) patients. The results showed that TTH presenteeism did not directly relate to health-related loss of productivity, either due to physical, or mental health problems. However, through anxiety-state, TTH presenteeism decreased patients' productivity, as consequence of reduced physical and mental health. Moreover, by increasing the severity of the Tension-Type Headache, TTH presenteeism indirectly decreased patients' productivity as consequence of reduced physical health (but not mental health). Finally, our results show that such indirect effects only occur when the cause of TTH is non-mechanical (e.g., hormonal causes, etc.). Our work provides an integrative model that can inform organizational behaviorists and health professionals (e.g., physiotherapists). Implications for organizational health are discussed.