Sleep Quality in Chronic Tension-Type Headaches

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Variance in sleep quality at baseline was associated with depression and the emotional burden of headache.
Variance in sleep quality at baseline was associated with depression and the emotional burden of headache.

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).

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.

Reference

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.

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