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21-07-2013 | Neurology | Article

Sleep quality a key contributor to migraine severity


Free abstract

medwireNews: Poor sleep quality directly contributes to migraine frequency and associated disability, report researchers who recommend targeting sleep quality when treating migraineurs.

Sleep quality was found to be worse for 78 patients experiencing episodic migraine than for 208 healthy control individuals, as indicated by a higher average Pittsburgh Sleep Quality Index (PSQI) score of 8.90 versus 6.63. And it was bad enough to be considered clinically significant (PSQI score >5) in more people with migraine than without, at 85.9% versus 62.0%.

Researchers Todd Smitherman (University of Mississippi, Oxford, USA) and colleagues note that poor sleep quality was significantly associated with headache frequency and headache-related disability, explaining a respective 14.8% and 18.2% of variance.

These are similar proportions to those attributed to depression and anxiety, they say, both of which were also more common in people with migraine than without.

Even after taking into account the presence of depression and anxiety, poor sleep quality accounted for 5.3% and 5.8% of unique variance in headache frequency and disability, respectively, which the researchers say is a “modest but non-trivial” amount.

They also point out that when depression and anxiety scores were entered in regression analyses after poor sleep quality, the affective symptoms did not significantly improve these analysis models beyond that of sleep quality alone.

“As such, the effects of poor sleep quality on migraine-related variables appear independent of, and potentially even more relevant than, comorbid affective symptoms,” they report.

Patients with migraine consistently engaged in poor sleep hygiene behaviors, but these behaviors did not distinguish them from controls, and although such behaviors contributed to migraine disability, the effect was no greater than that already afforded by poor sleep quality.

“As such, sleep quality should be assessed preferentially to other sleep disturbance variables when subjective self-report measures of insomnia are used,” say Smitherman and team in Headache.

They conclude that, “in light of the present findings, conclusions from systematic reviews, and practice guidelines, the most potent means of improving sleep quality and insomnia among migraineurs is likely a treatment package that incorporates stimulus control and/or sleep restriction in addition to basic sleep hygiene education and management of comorbid psychiatric symptoms.”

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lucy Piper, Senior medwireNews Reporter

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