Stress and sleep duration predict headache severity in chronic headache sufferers
Open accessAbstract
The objective of this study was to evaluate the time-series relationships between stress, sleep duration, and headache pain among patients with chronic headaches. Sleep and stress have long been recognized as potential triggers of episodic headache (<15 headache days/month), though prospective evidence is inconsistent and absent in patients diagnosed with chronic headaches (≥15 days/month). We reanalyzed data from a 28-day observational study of chronic migraine (n=33) and chronic tension-type headache (n=22) sufferers. Patients completed the Daily Stress Inventory and recorded headache and sleep variables using a daily sleep/headache diary. Stress ratings, duration of previous nights' sleep, and headache severity were modeled using a series of linear mixed models with random effects to account for individual differences in observed associations. Models were displayed using contour plots. Two consecutive days of either high stress or low sleep were strongly predictive of headache, whereas 2 days of low stress or adequate sleep were protective. When patterns of stress or sleep were divergent across days, headache risk was increased only when the earlier day was characterized by high stress or poor sleep. As predicted, headache activity in the combined model was highest when high stress and low sleep occurred concurrently during the prior 2 days, denoting an additive effect. Future research is needed to expand on current findings among chronic headache patients and to develop individualized models that account for multiple simultaneous influences of headache trigger factors.
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Sleep durations below 5 hours were associated with increased pain in all reviewed study types.
“Sleep durations below 5 hours were associated with increased pain in all of these study types.18,19,105–110”
Sleep durations of 7-8 or 8-9 hours were consistently associated with reduced pain symptoms.
“Sleep durations of 7–8 or 8–9 hours were consistently associated with reduced pain symptoms.18,105–109”
Sleep durations of 7-8 or 8-9 hours were consistently associated with reduced pain symptoms.
“Sleep durations of 7-8 or 8-9 hours were consistently associated with reduced pain symptoms.”
Sleep durations below 5 hours were associated with increased pain in all reviewed study types.
“Sleep durations below 5 hours were associated with increased pain in all of these study types.”
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- Authors
- Houle, T. T., Butschek, R. A., Turner, D. P., Smitherman, T. A., Rains, J. C., & Penzien, D. B.
- Affiliations
- Elliot Hospital (US)
- Wake Forest University Health Sciences (US)
- University of Mississippi (US)
- University of Mississippi Medical Center (US)
- Corresponding author
- Houle, Timothy T.
- Venue
- Pain
- Published
- 2012-12
- Volume
- 153
- Issue
- 12
- Pages
- 2432-2440
- ISSN
- 0304-3959 (ISSN-L)
- PMC
- PMC3626265
- OpenAlex
- W1989565773
- Cited by
- 188
- References
- 46
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 13 · 2023: 20 · 2022: 17 · 2021: 24 · 2020: 13 · 2019: 17 · 2018: 11 · 2017: 15 · 2016: 11 · 2015: 13 · 2014: 8 · 2013: 6 · 2012: 2
- FWCI
- 6.60
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (R01NS065257)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- chronic headache, chronic migraine, chronic tension-type headache, stress, sleep duration, headache severity, headache triggers, episodic headache, time series analysis
- MeSH terms
- Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, North Carolina, Risk Factors, Severity of Illness Index, Sleep Wake Disorders, Stress, Psychological, Comorbidity, Prevalence, Age Distribution, Sex Distribution, Headache Disorders, Young Adult
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