Sleep Quality in Chronic Tension-Type Headaches

woman with headache laying in bed
woman with headache laying in bed
Investigators examined baseline and 1-year variables and their association with quality of sleep in chronic tension-type headaches.

Chronic tension-type headache may negatively affect quality of sleep in patients who suffer from them, according to a report published in PLOS One. The contributing factors to sleep impairment may vary throughout the course of the disease.

The investigators analyzed data from a cross-sectional multicenter international headache study that included 180 patients. Of the 180 participants, 135 continued participation in an additional longitudinal study.

Patients were diagnosed with chronic tension-type headache, using criteria from the International Classification of Headache Disorders, third edition (ICHD-III).

Clinical features were assessed using a 4-week headache diary completed at baseline and at 1 year. Sleep quality was also measured at these points, using the Pittsburgh Sleep Quality Index. The following variables were assessed at baseline only: anxiety and depression (Hospital Anxiety and Depression Scale, or HADS), headache burden (Headache Disability Inventory, or HDI), quality of life (Medical Outcomes Study Short Form, or SF-36 questionnaire), and pressure pain thresholds.

The cross-sectional analysis evidenced a positive correlation between sleep quality and headache frequency (r, 0.241; P <.001), headache intensity (r, 0.194; P =.02), headache duration (r, 0.165; P =.04), depression (r, 0.502; P <.001), emotional burden (r, 0.374; P <.001), and physical burden (r, 0.259; P =.002).

The longitudinal study revealed a positive correlation between sleep quality and the following variables from baseline: emotional burden (r, 0.282; P =.03), physical burden (r, 0.226; P =.04), and depression (r, 0.367; P <.001). A negative correlation was evidenced between sleep quality and the following variables at baseline: all points of pressure pain thresholds, vitality (r, −0.386; P <.001), and mental health status (r, −0.365; P <.001).

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Using regression analyses, the researchers assessed that depression and emotional burden accounted for 27.5% of the variance in sleep quality at baseline (r2, 0.262; F, 23.72; P <.001); vitality, pain pressure threshold over the second metacarpal, and pain pressure threshold over the neck were responsible for 30.0% of variance at 1 year (r2, 0.269; F, 9.71; P <.001).

“It seems that sleep quality exhibits a complex interaction in individuals with [chronic tension-type headache] since depression and the emotional burden were associated with sleep quality at baseline, but vitality and [pain pressure thresholds] over extra-trigeminal areas were associated with the quality of sleep at one-year,” the authors wrote.


Benito-Gonzalez E, Palacios-Cena M, Fernandez-Munoz JJ, et al. Variables associated with sleep quality in chronic tension-type headache: A cross-sectional and longitudinal design. PLoS One. 2018;13(5):e0197381.