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Relationship between headaches and sleep: a longitudinal study
Introduction: Evidence in the literature showed an association between headache and sleep disturbances, especially when headaches occur during the night or early morning. Our group has demonstrated that waking up during the night with headache was prevalent (8.4%) in the Sao Paulo general population
Objective: We aimed to assess the incidence and associate sleep variables of "Nocturnal awakening with headache (NAH)“ in a prospective 8-year follow-up study.
Methods: From 1,042 volunteers enrolled in the baseline study, 712 agreed to participate to the follow-up study. Questionnaires and scales were applied and polysomnography (PSG) and actigraphy were performed. Sleep disorders were determined through sleep questionnaires, and also DSM-IV was used to characterize insomnia. Frequent NAH was defined by symptoms of at least once a week, occasional NAH was defined by symptoms frequency of less than once a month or 1 to 3 times a month and absence of NAH was defined by a negative response.
Results: From the 712 participants, 702 completed their NAH questionnaire. In the follow-up setting, 84.5% referred no NAH, 8.4% had occasional headache and 7.1% had frequent headache. There was a significant association between baseline frequent NAH with occasional NAH, as 17.7% of frequent NAH changed to occasional NAH. In the follow-up, frequent NAH was associated with female gender, higher body mass index (BMI), insomnia DSM-IV, lower self-reported sleep duration, higher insomnia severity index (ISI), objective longer sleep latency and higher mean wake time at actigraphy. After adjustment for sex and BMI, self-reported sleep duration, DSM-IV insomnia, ISI score, and objective sleep onset latency remained significantly associated with frequent NAH.
Conclusions: Our study shows that NAH was highly prevalent in the São Paulo population in both the baseline and follow-up studies with some sleep-related risk factors, mainly insomnia.
Keywords: nocturnal awakening, headache, sleep disorders.
Financial support: Associação Fundo de Incentivo à Pesquisa (AFIP) and São Paulo Research Foundation (FAPESP, #2018/00955-4 to PFT)
Ligia Mendonça Lucchesi, Priscila Farias Tempaku, Anna Karla Alves Smith, Sonia Togeiro, Helena Hachul, Monica Levy Andersen, Sergio Tufik, Dalva Poyares