Lack of sleep increases migraine-related pain and mental health burden

For migraine sufferers, poor sleep quality contributes to increased migraine risk and migraine pain, as well as reduced QOL and mental health.


Migraine has been shown to significantly reduce HRQOL and to have significant effects on daily activities, direct medical costs, and prevalence of comorbidities. Early detection of factors strongly associated with migraine is critical to reducing disease burden, with important implications for prevention, treatment, and prognosis.

Studies have also shown that migraines are associated with a wide range of sleep disorders. “Poor sleep is one of the most common sleep disorders in migraine patients and can have an impact on migraine chronicity,” says Zunjing Liu. However, data on associations between sleep quality and migraine risk has not been fully elucidated in clinical research.

The Pittsburgh Sleep Quality Index (PSQI) is a self-reported sleep quality questionnaire that assesses sleep quality over the past month and can be used to assess poor sleep quality in migraine patients. Given the previously documented relationships between sleep and migraine in published research, the PSQI score may be useful as a migraine predictor. However, some analyzes have reported the predictive value of the PSQI score for migraine.

For a study published in Frontiers in neuroscienceLiu and colleagues systematically explored the relationship between sleep quality and migraine risk. They also reviewed gender and age differences. They investigated the associations between sleep quality and total pain burden, severity, disability, headache effect, QOL, anxiety, and depression. Sleep quality was assessed using the PSQI. In all, 134 patients with migraine and 70 healthy controls matched for sex and age were included in the analysis.

Poor sleep is more common in migraine patients

According to the results, the prevalence of poor sleep quality in patients with migraine was significantly higher than in those without the headache disorder. “About two-thirds of patients with migraine had poor sleep quality, and poor sleep quality is significantly associated with an increased risk of migraine,” says Liu.

After adjusting for various confounding factors, the risk of migraine in those with poor sleep quality was still 3,981 times higher than in patients with good sleep quality. In addition, the authors note that PSQI scores have good diagnostic specificity for migraine.

In a subgroup analysis, the researchers noted significant additive interactions between poor sleep quality and migraine risk based on gender, age, and education level. Stronger associations were found in women, patients aged 35 and over, and in those with lower levels of education. (Table). Moreover, multivariate linear regression analysis showed that poor sleep quality was significantly and independently associated with total pain burden, severity, headache affect, QOL, anxiety, and depression in migraine patients.

Incorporating sleep quality in the treatment of migraine

Liu sees the associations between sleep quality and migraine-related burden as important topics that deserve more attention. The current study showed that poor sleep quality was significantly and independently associated with an increased risk of migraine and migraine-related burden. This information can be used to develop new interventions to improve the prevention and treatment of migraine-related burdens, according to Liu and colleagues.

The authors also recommend the use of PSQI ratings when evaluating migraine patients.

“The PSQI instrument is convenient, practical, and accurate for assessing sleep quality,” says Liu. “It could also guide early prevention efforts and sleep interventions when dealing with migraine patients.”

Since the PSQI score has good predictive accuracy and diagnostic specificity for migraine, it could be a potential predictor of migraine, but this requires further validation in future research.

The study team hopes to expand the sample size in future research to explore the effect of preventive treatment on the association between sleep quality and migraine. Studies are also needed to explore whether the associations between sleep quality and migraine are different based on whether patients receive migraine preventive treatments.

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