Insomnia Not Associated With Migraine and Tension Headache Diagnoses


Although not associated with diagnosis, investigators did conclude that substantial/very severe impact of headache attacks and anxiety were correlated with presence of insomnia.

Pedro Augusto Sampaio Rocha-Filho, MD, PhD, professor of neurology, and neurologist, Headache Clinic, Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco, Recife, Brazil

Pedro Augusto Sampaio Rocha-Filho, MD, PhD

Data from a recent study suggest that migraine and tension-type headache diagnoses were not associated with the presence of insomnia. However, substantial and very severe impact of headaches, as well as presence of anxiety, were associated with insomnia. Conversely, frequency of headache attacks and impact of headaches were also associated with severity of insomnia.

A total of 420 university students agreed to participate and were enrolled in the study, with a median age of 21 (standard deviation 19-23). Insomnia was found in 95 (22.6%) participants (95% CI, 18-26), 265 (63.1%) had migraine, 152 (36.2%) had tension-type headache, 182 (43.3%) had migraine with aura, 201 (47.9%) had anxiety, and 108 (35.7%) had depression. Students were asked to complete a semi-structured questionnaire about the characteristics of their headaches, as well as the frequency for the 3 months prior. The Headache Impact Test (HIT-6), Hospital Anxiety Depression Scale, and the Insomnia Severity Index were all utilized. 

Data show that presence of insomnia was associated with substantial or very severe impact of headache (HIT-6 score > 55 points; OR, 3.9 [95% CI, 2.3-6.6]; P = .003), and anxiety (OR, 3.6 [95% CI, 1.9-6.6]; P = .003), with investigators predicting university students who suffer from depression, anxiety, and severe headache have a 58.1% probability of also having insomnia. Comparably, for those that do not have depression, anxiety, or have substantial/very severe impact of headache, investigators predicted chances of developing insomnia at just 5.5%.

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“The prevalence of insomnia we found is within what is expected for the general population,” corresponding author Pedro Augusto Sampaio Rocha-Filho, MD, PhD, professor of neurology, and neurologist, Headache Clinic, Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco, Recife, Brazil, et al wrote. “However, the prevalence of headaches and migraine was higher than that of the general population. These findings suggest that the association between insomnia and headache disorders could be different from the general population. Therefore, the generalization of our results to the general population should be done with care.”

Investigators also found that 399 students (95%) reported headache prevalence in the last 12 months. Participants with anxiety (median: 13 [interquartile range (IQR), 9-13; median: 8 [IQR, 4–11]; P <.01), depression (median: 13 [IQR, 10-17]; median: 9 [IQR, 5-13]; P <.01), and migraine (median: 11 [IQR, 8-15]; median: 8 [IQR, 4-12]; P <.01) all had greater severity of insomnia. When compared to participants without these disorders, those with tension-type headache had lower severity of insomnia (median: 8 [IQR, 4.25-11.75]; median: 11 [IQR, 8-15]; P <.01). 

“Our study shows that the increased headache disability and the increased headache frequency and not the diagnosis of headache is associated with insomnia,” Rocha-Filho et al wrote. “We consider these findings to be of clinical importance. Most students with headache had a low frequency of attacks (median: 3 days/3months) and had low or no impact headaches (62%), not requiring prophylactic treatment. However, our results raise the possibility that the treatment of the headache with a higher impact and frequency may have a positive impact on insomnia and vice versa.”

Investigators were unable to observe a causal relationship, as information on insomnia and headache were collected in one instance. Variables such as the labor market, consuming drinks, smoking cigarettes, taking drugs, and engaging in physical activities—all of which can be related to insomnia—were not included in analyses. Additionally, there was no physical examination, eliminating inclusion of secondary headache; however, investigators attempted to address this by having headache diagnoses be given by a neurologist.

1. Rangel TC, Raposo MCF, Rocha-Filho, Rocha-Filho PAS. The prevalence and severity of insomnia in university students and their associations with migraine, tension-type headache, anxiety and depression disorders: a cross sectional study. Sleep Med. Published online October 30, 2021. doi:10.1016/j.sleep.2021.10.029
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