Sleep Predicts Migraine Recurrence

— Sleep quality may identify patients at risk of developing chronic migraine


Sleep quality at a single time point was tied to headaches occurring over the next 6 weeks among people with episodic migraine, a prospective study presented at the annual meeting showed.

Baseline poor sleep quality in episodic migraine patients was associated with a 22% on each day over the following 6 weeks, reported Angeliki Vgontzas, MD, of Brigham and Women's Hospital in Boston, and co-authors.

"This is the first study to show that a baseline report of poor sleep quality may be able to identify patients with higher future headache burden," Vgontzas told app.

"Taken together with other studies that report increased sleep complaints in those with chronic migraine, we believe that baseline assessment of poor sleep quality in those with episodic migraine may help identify those at risk of developing chronic migraine," she added.

Disordered sleep, poor sleep quality, and insufficient or excessive sleep duration are of migraine and tension-type headaches. The large, population-based of nearly 13,000 migraine patients showed that were more likely to report poor sleep quality -- including sleep disturbance, snoring, shortness of breath, and somnolence -- and were less likely to report sleep adequacy than episodic migraine patients.

In their analysis, Vgontzas and colleagues studied 98 adults with episodic migraine, defined by criteria. Participants had an average age of 35 and 88% were women; they had a baseline average of five migraine headaches a month.

At the start of the study, participants completed questionnaires about depressive symptoms (Center for Epidemiological Studies Depression scale; ), stress (10-item Perceived Stress Scale; ), and sleep quality (Pittsburgh Sleep Quality Index; ). Over the next 6 weeks, participants reported headaches in daily morning and evening electronic diaries.

Baseline data showed that 46% of participants had poor sleep quality (PSQI score ≥5), 18% had high depressive symptoms (CES-D score ≥16), and 52% reported moderate or high stress levels (PSS-10 score ≥14). About one in four participants (26.5%) were using migraine prophylactic medication.

The researchers conducted time-to-event analyses to estimate whether screening questionnaire information was tied to headache recurrence, adjusting for sex, age, caffeine, alcohol, exercise, and baseline headache days.

Participants reported 823 discrete headaches over 4,406 study days. Poor sleep quality was associated with a 22% higher rate of headache recurrence (HR 1.22; 95% CI 1.02-1.46). Moderate or high stress showed an HR of 1.12 (95% CI 0.93-1.35) with headache recurrence, and depressive symptoms showed an HR of 0.93 (95% CI 0.69-1.26).

"Although we know that people with higher frequency of migraine report more sleep problems, including with their sleep quality, we don't know which comes first," Vgontzas said.

"There may also be another factor -- perhaps genetic, biological, or behavioral -- driving both," she added. "We are interested in looking at the interaction between stress and sleep and how this may influence migraine occurrence as well."

The study has limitations: it did not use polysomnography, the gold standard for assessing sleep, and all data were self-reported. Respondents also had generally low rates of depression, the researchers noted.

  • Judy George covers neurology and neuroscience news for app, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more.


Funding for this study came from the American Academy of Sleep Medicine Foundation and NIH awards.

Primary Source

American Headache Society

Vgontzas A, et al "Poor Sleep Quality, Stress and Depressive Symptoms and Subsequent Headache in Patients With Episodic Migraine: A Prospective Cohort Study" AHS 2020.