Sleep Disturbance Linked to Tension Headache

Laurie Barclay, MD

February 16, 2009

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February 16, 2009 — Sleep-seeking behavior to relieve pain may contribute to the development of insomnia in people with tension-type headache, according to the results of a study published in the February 15 issue of the Journal of Clinical Sleep Medicine.

"Insomnia has been identified as a risk factor for tension-type headache, although the pathogenesis of sleep disturbance in this population is unclear," write Jason C. Ong, PhD, from Rush University Medical Center in Chicago, Illinois, and colleagues. "The present study examined pain-related self-management strategies in a nonclinical, young-adult sample for preliminary evidence to support a novel hypothesis for the development of insomnia in this population."

The study sample consisted of 32 women with tension-type headache and 33 women with minimal pain who served as control subjects. The investigators studied self-report data on headache triggers, pain interference with sleep, and self-management strategies for pain.

Compared with the control group, the headache group had a significantly greater proportion of participants who reported sleep problems as a trigger of headaches, stress as a trigger of headache, and going to sleep as a strategy for dealing with pain. Ratings of pain interference with sleep were significantly higher in the headache group. Among the headache group, 81% reported that going to sleep was the most frequently used self-management strategy, and this group also rated going to sleep as the most effective strategy (5.5/7.0).

"These findings suggest that a bidirectional relationship between sleep disturbance and headache is present in this young-adult sample," the study authors write. "Furthermore, the frequent use of sleep as a self-management strategy for pain is consistent with the hypothesis that sleep-seeking behavior might be a mediating factor in the development of insomnia among people with tension-type headache. This hypothesis fits within the most widely accepted conceptual model of chronic insomnia and should be further investigated in individuals with both tension-type headache and insomnia."

Limitations of this study include secondary analyses from a primary study assessing psychophysiological correlates of people with headache, data unavailable for sleep-wake patterns or sleep quality, inability to generalize the findings to other types of headache, and unknown temporal relationship of headaches and sleep disturbance.

"The assessment of daytime napping behaviors among individuals who report insomnia and headaches might be particularly important for behavioral sleep interventions, and clinicians should be sensitive to the dilemma of managing pain and sleep disturbance," the study authors conclude. "Uncovering the mechanisms of the reciprocal relationship between headache and sleep remains challenging, but identifying specific behavioral risk factors could provide targets for improving treatment in this comorbid population."

This study was funded in part by a Southern Regional Education Board Dissertation Year Fellowship awarded to Dr. Ong. The study authors have disclosed no relevant financial relationships.

J Clin Sleep Med. 2009;5:52-56.


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