Search tips
Search criteria 


Logo of headpainSpringerOpen.comSubmit OnlineRegisterThis journalThis article
J Headache Pain. 2010 June; 11(3): 197–206.
Published online 2010 March 12. doi:  10.1007/s10194-010-0201-8
PMCID: PMC3451918

Associations between sleep disturbance and primary headaches: the third Nord-Trøndelag Health Study


The aim of the study was to evaluate the association between sleep disturbance and headache type and frequency, in a random sample of participants in the third Nord-Trøndelag Health Survey. The headache diagnoses were set by neurologists using the ICHD-2 criteria performing a semi structured face-to-face interview. Sleep problems were measured by the two validated instruments Karolinska Sleep Questionnaire (KSQ) and Epworth Sleepiness Scale (ESS). Among 297 participants, 77 subjects were headache-free, whereas 135 were diagnosed with tension-type headache (TTH), 51 with migraine, and 34 with other headache diagnoses. In the multivariate analyses, using logistic regression, excessive daytime sleepiness, defined as ESS ≥ 10, was three times more likely among migraineurs compared with headache-free individuals (OR = 3.3, 95% CI 1.0–10.2). Severe sleep disturbances, defined as KSQ score in the upper quartile, was five times more likely among migraineurs (OR = 5.4, 95% CI 2.0–15.5), and three times more likely for subjects with TTH (OR = 3.3, 1.4–7.3) compared with headache-free individuals. Subjects with chronic headache were 17 times more likely to have severe sleep disturbances (OR = 17.4, 95% CI 5.1–59.8), and the association was somewhat stronger for chronic migraine (OR = 38.9, 95% CI 3.1–485.3) than for chronic TTH (OR = 18.3, 95% CI 3.6–93.0). In conclusion, there was a significant association between severe sleep disturbances and primary headache disorders, most pronounced for those with chronic headache. Even though one cannot address causality in the present study design, the results indicate an increased awareness of sleep problems among patients with headache.

Full Text

The Full Text of this article is available as a PDF (279K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
1. Alberti A. Headache and sleep. Sleep Med Rev. 2006;10:431–437. doi: 10.1016/j.smrv.2006.03.003. [PubMed] [Cross Ref]
2. Leger D, Poursain B, Neubauer D, Uchiyama M. An international survey of sleeping problems in the general population. Curr Med Res Opin. 2008;24:307–317. doi: 10.1185/030079907X253771. [PubMed] [Cross Ref]
3. Stovner LJ, Hagen K. Prevalence, burden, and cost of headache disorders. Curr Opin Neurol. 2006;19:281–285. doi: 10.1097/01.wco.0000227039.16071.92. [PubMed] [Cross Ref]
4. Menefee LA, Frank ED, Doghramji K, Picarello K, Park JJ, Jalali S, Perez-Schwartz L. Self-reported sleep quality and quality of life for individuals with chronic pain conditions. Clin J Pain. 2000;16:290–297. doi: 10.1097/00002508-200012000-00003. [PubMed] [Cross Ref]
5. Moldofsky H. Sleep and pain. Sleep Med Rev. 2001;5:385–396. doi: 10.1053/smrv.2001.0179. [PubMed] [Cross Ref]
6. Poceta JS. Sleep-related headache syndromes. Curr Pain Headache Rep. 2003;7:281–287. doi: 10.1007/s11916-003-0048-7. [PubMed] [Cross Ref]
7. Jennum P, Jensen R. Sleep and headache. Sleep Med Rev. 2002;6:471–479. doi: 10.1053/smrv.2001.0223. [PubMed] [Cross Ref]
8. Rains JC, Poceta JS, Penzien DB. Sleep and headaches. Curr Neurol Neurosci Rep. 2008;8:167–175. doi: 10.1007/s11910-008-0027-9. [PubMed] [Cross Ref]
9. Boardman HF, Thomas E, Millson DS, Croft PR. Psychological, sleep, lifestyle, and comorbid associations with headache. Headache. 2005;45:657–669. doi: 10.1111/j.1526-4610.2005.05133.x. [PubMed] [Cross Ref]
10. Rasmussen BK. Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain. 1993;53:65–72. doi: 10.1016/0304-3959(93)90057-V. [PubMed] [Cross Ref]
11. Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R. Prognosis of migraine and tension-type headache: a population-based follow-up study. Neurology. 2005;65:580–585. doi: 10.1212/01.wnl.0000172918.74999.8a. [PubMed] [Cross Ref]
12. Langemark M, Olesen J, Poulsen DL, Bech P. Clinical characterization of patients with chronic tension headache. Headache. 1988;28:590–596. doi: 10.1111/j.1526-4610.1988.hed2809590.x. [PubMed] [Cross Ref]
13. Ong JC, Stepanski EJ, Gramling SE. Pain coping strategies for tension-type headache: possible implications for insomnia? J Clin Sleep Med. 2009;5:52–56. [PubMed]
14. Gilman DK, Palermo TM, Kabbouche MA, Hershey AD, Powers SW. Primary headache and sleep disturbances in adolescents. Headache. 2007;47:1189–1194. doi: 10.1111/j.1526-4610.2007.00885.x. [PubMed] [Cross Ref]
15. Miller VA, Palermo TM, Powers SW, Scher MS, Hershey AD. Migraine headaches and sleep disturbances in children. Headache. 2003;43:362–368. doi: 10.1046/j.1526-4610.2003.03071.x. [PubMed] [Cross Ref]
16. Isik U, Ersu RH, Ay P, Save D, Arman AR, Karakoc F, Dagli E. Prevalence of headache and its association with sleep disorders in children. Pediatr Neurol. 2007;36:146–151. doi: 10.1016/j.pediatrneurol.2006.11.006. [PubMed] [Cross Ref]
17. Sand T, Hagen K, Schrader H. Sleep apnoea and chronic headache. Cephalalgia. 2003;23:90–95. doi: 10.1046/j.1468-2982.2003.00460.x. [PubMed] [Cross Ref]
18. Seidel S, Hartl T, Weber M, Matterey S, Paul A, Riederer F, Gharabaghi M, Wober-Bingol C, Wober C (2009) Quality of sleep, fatigue and daytime sleepiness in migraine—a controlled study. Cephalalgia. doi:10.1111/j.1468-2982.2008.01784.x.
19. Gupta R, Bhatia MS, Dahiya D, Sharma S, Sapra R, Semalti K, Dua RP. Impact of primary headaches on subjective sleep parameters among adolescents. Ann Indian Acad Neurol. 2008;11:164–169. doi: 10.4103/0972-2327.42936. [PMC free article] [PubMed] [Cross Ref]
20. Blau JN. Resolution of migraine attacks: sleep and the recovery phase. J Neurol Neurosurg Psychiatry. 1982;45:223–226. doi: 10.1136/jnnp.45.3.223. [PMC free article] [PubMed] [Cross Ref]
21. Goder R, Fritzer G, Kapsokalyvas A, Kropp P, Niederberger U, Strenge H, Gerber WD, Aldenhoff JB. Polysomnographic findings in nights preceding a migraine attack. Cephalalgia. 2001;21:31–37. doi: 10.1046/j.1468-2982.2001.00141.x. [PubMed] [Cross Ref]
22. Kelman L, Rains JC. Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache. 2005;45:904–910. doi: 10.1111/j.1526-4610.2005.05159.x. [PubMed] [Cross Ref]
23. Peres MF, Stiles MA, Siow HC, Silberstein SD. Excessive daytime sleepiness in migraine patients. J Neurol Neurosurg Psychiatry. 2005;76:1467–1468. doi: 10.1136/jnnp.2005.062497. [PMC free article] [PubMed] [Cross Ref]
24. Spierings EL, Ranke AH, Honkoop PC. Precipitating and aggravating factors of migraine versus tension-type headache. Headache. 2001;41:554–558. doi: 10.1046/j.1526-4610.2001.041006554.x. [PubMed] [Cross Ref]
25. Bruni O, Fabrizi P, Ottaviano S, Cortesi F, Giannotti F, Guidetti V. Prevalence of sleep disorders in childhood and adolescence with headache: a case-control study. Cephalalgia. 1997;17:492–498. doi: 10.1046/j.1468-2982.1997.1704492.x. [PubMed] [Cross Ref]
26. Heng K, Wirrell E. Sleep disturbance in children with migraine. J Child Neurol. 2006;21:761–766. doi: 10.1177/08830738060210092201. [PubMed] [Cross Ref]
27. Barbanti P, Fabbrini G, Aurilia C, Vanacore N, Cruccu G. A case-control study on excessive daytime sleepiness in episodic migraine. Cephalalgia. 2007;27:1115–1119. doi: 10.1111/j.1468-2982.2007.01399.x. [PubMed] [Cross Ref]
28. Boardman HF, Thomas E, Millson DS, Croft PR. The natural history of headache: predictors of onset and recovery. Cephalalgia. 2006;26:1080–1088. doi: 10.1111/j.1468-2982.2006.01166.x. [PubMed] [Cross Ref]
29. Wober C, Brannath W, Schmidt K, Kapitan M, Rudel E, Wessely P, Wober-Bingol C. Prospective analysis of factors related to migraine attacks: the PAMINA study. Cephalalgia. 2007;27:304–314. doi: 10.1111/j.1468-2982.2007.01279.x. [PubMed] [Cross Ref]
30. Hagen K, Zwart JA, Aamodt AH, Nilsen KB, Brathen G, Helde G, Stjern M, Tronvik EA, Stovner LJ. A face-to-face interview of participants in HUNT 3: the impact of the screening question on headache prevalence. J Headache Pain. 2008;9:289–294. doi: 10.1007/s10194-008-0062-6. [PMC free article] [PubMed] [Cross Ref]
31. Axelsson J, Kecklund G, Åkerstedt T, Ekstedt M, Menenga J. A comparison of the Karolinska Sleep Questionnaire and the Karolinska Sleep Diary: a methodological study [abstract] J Sleep Res. 2002;11:1–8.
32. Eriksen CA, Kecklund G. Sleep, sleepiness and health complaints in police officers: the effects of a flexible shift system. Ind Health. 2007;45:279–288. doi: 10.2486/indhealth.45.279. [PubMed] [Cross Ref]
33. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–545. [PubMed]
34. Hagen K, Zwart JA, Vatten L, Stovner LJ, Bovim G. Head-HUNT: validity and reliability of a headache questionnaire in a large population-based study in Norway. Cephalalgia. 2000;20:244–251. doi: 10.1046/j.1468-2982.2000.00049.x. [PubMed] [Cross Ref]
35. Ebbesen MH, Hannestad YS, Midthjell K, Hunskaar S. Diabetes related risk factors did not explain the increased risk for urinary incontinence among women with diabetes. The Norwegian HUNT/EPINCONT study. BMC Urol. 2009;9:11. doi: 10.1186/1471-2490-9-11. [PMC free article] [PubMed] [Cross Ref]
36. Silberstein SD, Olesen J, Bousser MG, Diener HC, Dodick D, First M, Goadsby PJ, Gobel H, Lainez MJ, Lance JW, Lipton RB, Nappi G, Sakai F, Schoenen J, Steiner TJ. The international classification of headache disorders, 2nd edition (ICHD-II)—revision of criteria for 8.2 Medication-overuse headache. Cephalalgia. 2005;25:460–465. doi: 10.1111/j.1468-2982.2005.00878.x. [PubMed] [Cross Ref]
37. Olesen J, Bousser MG, Diener HC, Dodick D, First M, Goadsby PJ, Gobel H, Lainez MJ, Lance JW, Lipton RB, Nappi G, Sakai F, Schoenen J, Silberstein SD, Steiner TJ. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia. 2006;26:742–746. doi: 10.1111/j.1468-2982.2006.01172.x. [PubMed] [Cross Ref]
38. Akerstedt T, Ingre M, Broman JE, Kecklund G. Disturbed sleep in shift workers, day workers, and insomniacs. Chronobiol Int. 2008;25:333–348. doi: 10.1080/07420520802113922. [PubMed] [Cross Ref]
39. Akerstedt T, Knutsson A, Westerholm P, Theorell T, Alfredsson L, Kecklund G. Sleep disturbances, work stress and work hours: a cross-sectional study. J Psychosom Res. 2002;53:741–748. doi: 10.1016/S0022-3999(02)00333-1. [PubMed] [Cross Ref]
40. Leineweber C, Kecklund G, Akerstedt T, Janszky I, Orth-Gomer K. Snoring and the metabolic syndrome in women. Sleep Med. 2003;4:531–536. doi: 10.1016/S1389-9457(03)00160-6. [PubMed] [Cross Ref]
41. Leineweber C, Kecklund G, Orth-Gomer K. Prediction of cardiocerebrovascular and other significant disease from disturbed sleep and work strain. Scand J Work Environ Health. 2007;33:215–222. [PubMed]
42. Sterud T, Hem E, Ekeberg O, Lau B. Health problems and help-seeking in a nationwide sample of operational Norwegian ambulance personnel. BMC Public Health. 2008;8:3. doi: 10.1186/1471-2458-8-3. [PMC free article] [PubMed] [Cross Ref]
43. Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15:376–381. [PubMed]
44. Curcio G, Casagrande M, Bertini M. Sleepiness: evaluating and quantifying methods. Int J Psychophysiol. 2001;41:251–263. doi: 10.1016/S0167-8760(01)00138-6. [PubMed] [Cross Ref]
45. Johns MW. Sleepiness in different situations measured by the Epworth Sleepiness Scale. Sleep. 1994;17:703–710. [PubMed]
46. Benbadis SR, Mascha E, Perry MC, Wolgamuth BR, Smolley LA, Dinner DS. Association between the Epworth sleepiness scale and the multiple sleep latency test in a clinical population. Ann Intern Med. 1999;130:289–292. [PubMed]
47. Chervin RD, Aldrich MS. The Epworth Sleepiness Scale may not reflect objective measures of sleepiness or sleep apnea. Neurology. 1999;52:125–131. [PubMed]
48. Furuta H, Kaneda R, Kosaka K, Arai H, Sano J, Koshino Y. Epworth Sleepiness Scale and sleep studies in patients with obstructive sleep apnea syndrome. Psychiatry Clin Neurosci. 1999;53:301–302. doi: 10.1046/j.1440-1819.1999.00511.x. [PubMed] [Cross Ref]
49. Augestad LB, Slettemoen RP, Flanders WD. Physical activity and depressive symptoms among Norwegian adults aged 20–50. Public Health Nurs. 2008;25:536–545. [PubMed]
50. Baekken PM, Skorpen F, Stordal E, Zwart JA, Hagen K. Depression and anxiety in relation to catechol-O-methyltransferase Val158Met genotype in the general population: the Nord-Trondelag Health Study (HUNT) BMC Psychiatry. 2008;8:48. doi: 10.1186/1471-244X-8-48. [PMC free article] [PubMed] [Cross Ref]
51. Panicker V, Evans J, Bjoro T, Asvold BO, Dayan CM, Bjerkeset O. A paradoxical difference in relationship between anxiety, depression and thyroid function in subjects on and not on T4: findings from the HUNT study. Clin Endocrinol (Oxf) 2009;71:574–580. doi: 10.1111/j.1365-2265.2008.03521.x. [PubMed] [Cross Ref]
52. Chen PK, Fuh JL, Chen SP, Wang SJ (2009) Association between Restless Legs Syndrome and Migraine. J Neurol Neurosurg Psychiatry.
53. d’Onofrio F, Bussone G, Cologno D, Petretta V, Buzzi MG, Tedeschi G, Bonavita V, Cicarelli G. Restless legs syndrome and primary headaches: a clinical study. Neurol Sci. 2008;29(1):S169–S172. doi: 10.1007/s10072-008-0916-3. [PubMed] [Cross Ref]
54. Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev. 2004;8:119–132. doi: 10.1016/S1087-0792(03)00044-3. [PubMed] [Cross Ref]
55. Foo H, Mason P. Brainstem modulation of pain during sleep and waking. Sleep Med Rev. 2003;7:145–154. doi: 10.1053/smrv.2002.0224. [PubMed] [Cross Ref]
56. Lautenbacher S, Kundermann B, Krieg JC. Sleep deprivation and pain perception. Sleep Med Rev. 2006;10:357–369. doi: 10.1016/j.smrv.2005.08.001. [PubMed] [Cross Ref]
57. Rains JC. Chronic headache and potentially modifiable risk factors: screening and behavioral management of sleep disorders. Headache. 2008;48:32–39. doi: 10.1111/j.1526-4610.2008.01119_1.x. [PubMed] [Cross Ref]
58. Dodick DW, Eross EJ, Parish JM, Silber M. Clinical, anatomical, and physiologic relationship between sleep and headache. Headache. 2003;43:282–292. doi: 10.1046/j.1526-4610.2003.03055.x. [PubMed] [Cross Ref]
59. Montagna P. Hypothalamus, sleep and headaches. Neurol Sci. 2006;27(2):S138–S143. doi: 10.1007/s10072-006-0589-8. [PubMed] [Cross Ref]
60. Afridi SK, Giffin NJ, Kaube H, Friston KJ, Ward NS, Frackowiak RS, Goadsby PJ. A positron emission tomographic study in spontaneous migraine. Arch Neurol. 2005;62:1270–1275. doi: 10.1001/archneur.62.8.1270. [PubMed] [Cross Ref]
61. Weiller C, May A, Limmroth V, Juptner M, Kaube H, Schayck RV, Coenen HH, Diener HC. Brain stem activation in spontaneous human migraine attacks. Nat Med. 1995;1:658–660. doi: 10.1038/nm0795-658. [PubMed] [Cross Ref]
62. Denuelle M, Fabre N, Payoux P, Chollet F, Geraud G. Hypothalamic activation in spontaneous migraine attacks. Headache. 2007;47:1418–1426. [PubMed]
63. Alstadhaug KB. Migraine and the hypothalamus. Cephalalgia. 2009;29:809–817. doi: 10.1111/j.1468-2982.2008.01814.x. [PubMed] [Cross Ref]
64. Vgontzas A, Cui L, Merikangas KR. Are sleep difficulties associated with migraine attributable to anxiety and depression? Headache. 2008;48:1451–1459. doi: 10.1111/j.1526-4610.2008.01175.x. [PMC free article] [PubMed] [Cross Ref]

Articles from The Journal of Headache and Pain are provided here courtesy of Springer