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Headache and Sleep: Examination of Sleep
Patterns and Complaints in a Large Clinical Sample
Leslie Kelman MD, Jeanetta C. Rains PhD.
Posted: January 2006
Objectives: This study characterized
sleep parameters and complaints in a large clinical sample of
migraineurs and examined sleep complaints in relation to headache
frequency and severity.
Background: The relationship between headache and
sleep has been documented at least anecdotally in medical
literature for well over a century and clinical texts allude to
the importance of sleep as a headache precipitant. A small number
of empirical studies have emerged, but the precise nature and
magnitude of the headache/sleep association and underlying
mechanisms remain poorly understood.
Methods: In this investigation, 1283 migraineurs
were drawn from 1480 consecutive headache sufferers presenting for
evaluation to a tertiary headache clinic.
Results: Sleep complaints were common and associated
with headache in a sizeable proportion of patients. Over half of
migraineurs reported difficulty initiating and maintaining sleep
at least occasionally. Many in this sample reported chronically
shortened sleep patterns similar to that observed in persons with
insomnia, with 38% of patients sleeping on average 6 hours for
night. Migraines were triggered by sleep disturbance in 50% of
patients. "Awakening headaches" or headaches awakening them
from sleep were reported by 71% of patients. Interestingly,
sleep was also a common palliative agent for headache; 85% of
migraineurs indicated that they chose to sleep or rest because of
headache and 75% were forced to sleep or rest because of
headache. Patients with chronic migraine reported shorter nightly
sleep times than those with episodic migraine, and were more
likely to exhibit trouble falling asleep, staying asleep, sleep
triggering headache, and choosing to sleep because of headache.
Short sleepers (average sleep period 6 hours) exhibited significantly
more frequent and more severe headaches than individuals who slept
longer and were more likely to exhibit morning headaches on
Conclusions: These data support earlier research
and anecdotal observations of a substantial sleep/migraine
relationship, and implicate sleep disturbance in specific headache
patterns and severity. The short sleep group, who routinely slept
6 hours per night, exhibited the more severe headache patterns and
more sleep-related headache. Sleep complaints occurred with
greater frequency among chronic than episodic migraineurs. Future
research may identify possible mediating factors such as primary
sleep and mood disorders. Prospective studies are needed to
determine if normalizing sleep times in the short sleeps would
impact headache threshold.