Study finds behavioral link between insomnia and tension-type headaches

18 feb 2009--Using sleep or napping to cope with chronic pain caused by tension-type headaches could lead to chronic insomnia according to a new study by researchers at Rush University Medical Center. The study, published in the February 15 issue of the Journal of Clinical Sleep Medicine, found that napping to relieve headache pain could serve as a behavioral link between headache and sleep disturbance.

The study compared a group of 32 women who were confirmed to have tension-type headaches, as classified by the International Headache Society System, to a control group of 33 women who experience minimal pain.

Eighty-one percent of the women in the headache group reported going to sleep as a way of managing their headaches; this method was also rated as the most effective self-management strategy for pain.

Principal investigator and lead author, Jason C. Ong, PhD, assistant professor of behavioral sciences at Rush University Medical Center, said the extent to which the headache sufferers rated sleep as being an effective method for coping with pain was somewhat surprising.

"Insomnia is a common complaint among headache sufferers. While napping may relieve pain, it may also decrease the brain's need for sleep at night, leading to reduced ability to initiate and maintain sleep at night," said Ong.

The study found 58 percent of those with tension-type headaches reported sleep problems as a trigger of headaches compared to 18 percent of those who only suffer minimal headache pain. Similar studies have found that sleep disturbances, which include difficulty falling asleep or staying asleep, have been identified as a risk factor for developing chronic headaches.

Women in the headache group also reported a significantly higher rating of pain interfering with sleep compared to the control group. No significant differences were found between the groups on use of medication to relieve headaches.

Ong encourages further behavioral treatment studies to examine alternative coping strategies for pain that do not involve sleep. He notes that clinicians should be sensitive to the dilemma of managing pain and sleep disturbances.

In addition, the study concludes that medical experts should assess daytime napping behaviors among individuals who report insomnia and headaches. Such an assessment may be important for developing behavioral sleep interventions.

The study involved 65 women recruited from undergraduate psychology courses at a university located in the southeastern U.S. The average age of members of the headache group was 21.9 years, while the average age of the control group was 18.9 years.

The average time since the first headache of any type was 9.4 years for participants in the headache group, with an average of 8.11 headache days per month. Participants reported an average of 12.2 tension-type headaches over the past year, and 2.1 tension-type headaches in the past month, with a median duration of 2.0 hours. The average tension-type headache intensity rating using a 0-to-10 scale was 5.6. Six participants in the headache group also met criteria for migraine disorder.

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Founded in 1978, the Sleep Disorders Center at Rush was the first such center in Illinois and the first in the region to receive accreditation from the American Academy of Sleep Medicine (then the American Sleep Disorders Association). The staff of the Sleep Disorders Service and Research Center has established a national reputation for clinical excellence, for innovation in sleep medicine research and for providing superior training to the next generation of sleep professionals.