Sleep quality, energy, stress associated with incident headache onset

Key takeaways:

• The study 477 individuals and 4,974 assessments of headache over 2 weeks.
• Mood, anxiety disorders were not significantly associated with headache.

Poor sleep quality and low energy on the previous day were associated with incident morning headache, while higher than average energy levels and stress were linked to later-day headache onset, researchers reported in Neurology.

“Migraine headaches are highly prevalent across the lifespan and are often associated with significant functional impairment,” Tarannum M. Lateef, MD, MPH, director of Woodbridge Neurology Clinic at Pediatric Specialists of Virginia, and colleagues wrote. “One of the major challenges to effective treatment is pervasive comorbidity with a range of disorders, particularly mood disorders.”

Researchers sought to examine associations between mood, sleep, energy, stress and incident headache among individuals with migraine and/or mood disorders and whether predictors of headache differed by time of day.

Their cross-sectional, observational study included 477 individuals aged 7 to 84 years (61% women; 84% white) enrolled in the National Institute of Mental Health’s Family Study of Affective Spectrum Disorders.

Participants underwent a total of 4,974 assessments of headache syndromes and mental disorders, including the Ecological Momentary Assessment, which was conducted four times per day between 7 a.m. and 10 p.m. over the 2-week study period. They also wore actigraphy monitors to collect data on activity and sleep duration and reported presence of headache at each of the four daily time points.

Primary outcomes for analysis were incident morning and later-day headaches, defined as a new-onset occurrence not present at the two previous daily assessments.

Researchers employed generalized linear mixed-effects models to evaluate both average and lagged values of headache predictors, including subjectively rated mood, anxiety, energy, stress and sleep quality, and objectively measured sleep duration and efficiency on incident morning and later-day headaches.

According to results, both male and female participants with migraine histories were more likely to have at least one morning and later-day attack compared with those without prior migraine history. Additionally, female study participants had significantly higher levels of sad and anxious moods for the study duration.

After adjusting for demographic and clinical covariates as well as emotional states, incident morning headache was associated with lower average (beta = −0.206; 95% CI, −0.397 to −0.017) and decrease in average sleep quality on the previous day (beta = −0.172; 95% CI, −0.305 to −0.039).

Researchers also found that stress and change in reported energy levels on the previous day were associated with incident headache, with a decrease (beta = −0.145; 95% CI, −0.286 to −0.005) for morning headache and an increase (beta = 0.157; 95% CI, 0.032- 0.281) for headache later in the day. Mood and anxiety disorders were not significantly associated with incident headache after controlling for migraine history.

“This work contributes to our understanding of both the stable and proximal predictors or headache,” Lateef and colleagues wrote.