{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:23:11Z","timestamp":1780471391176,"version":"3.54.1"},"reference-count":65,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 (&lt;18, 18\u201364, and \u226565 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.<\/jats:p>","DOI":"10.3390\/jcm15114181","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T17:36:18Z","timestamp":1780076178000},"page":"4181","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Economic Distress on Primary Headache Visits Under the Strain of the COVID-19 Pandemic: A Retrospective Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3475-6474","authenticated-orcid":false,"given":"Merih Can","family":"Yilmaz","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, VM Medical Park Hospital, 55200 Samsun, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0579-9432","authenticated-orcid":false,"given":"Ozgur","family":"Ozaydin","sequence":"additional","affiliation":[{"name":"Department of Economics, Ondokuz Mayis University, 55270 Samsun, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keramettin","family":"Aydin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, VM Medical Park Hospital, 55200 Samsun, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1023\/A:1005552814010","article-title":"Socioeconomic differences in self-assessed health in a chronically ill population: The role of different health aspects","volume":"23","author":"Simon","year":"2000","journal-title":"J. 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