Headache Medicine 2020, 11(2):44-47 ISSN 2178-7468, e-ISSN 2763-6178

ASAA

DOI: 10.48208/HeadacheMed.2020.13

Headache Medicine

Original

Headache triggered by sleep deprivation: an observational study

Matheus Saraiva Valente Rosado

Raimundo Silva-Néto

Neurology Federal University of Delta of Parnaíba, Parnaíba, Piauí, Brazil.

Abstract

Introduction

Sleep deprivation is one of the main triggers of primary headaches, especially in migraine

patients.

Objective

To determine the prevalence of headache triggered by sleep deprivation in night workers.

Methods

The study was cross-sectional, observational, non-random and convenience. We interviewed

71 night workers of a public hospital with diagnosis of primary headaches and presence of

headache the day after night shift.

Results

The 71 night workers (50 women and 21 men) had a mean age of 36.7±7.7 years, ranging

from 22 to 50 years. Of these workers, 83.2% were diagnosed with migraine and 16.9%

with tension-type headache (TTH). The number of monthly night shifts was greater than 10,

in 50.8% of migraine patients and in 58.3% of those with TTH. It was observed that 91.5%

of migraine patients and 83.3% of patients with TTH slept ≥ 6 hours a night when they were

at home, but when they were at work, they all slept ≤ 4 hours a night. Headache occurred

the following day of night work in 83.1% of migraine patients and in 41.7% of those with

TTH (p=0.005).

Conclusion

Headache triggered by sleep deprivation was highly prevalent, predominating in migraine

patients.

Raimundo Silva-Néto

netoesperantina@terra.com.br

Received: April 13, 2020.

Accepted: April 27, 2020.

Edited by

Mario Fernando Prieto Peres

Keywords:

Headache

Sleep

Migraine Disorders

Prevalence

ASAA

Rosado MSV, Silva-Néto RN.

Headache triggered by sleep deprivation an observational study

Introduction

n primary headaches, headache attacks may be triggered by

several factors, such as stress, eating habits, sensory stimuli,

menstrual changes and sleep deprivation, especially in patients with

migraine.

1,2

The prevalence of headache attacks triggered by sleep

deprivation in migraine patients ranges from 28.5% to 56.7%

3,4,5

and in patients with tension-type headache (TTH) it is 28.8%

There is a relationship between sleep and primary headaches as

a trigger for headache attacks, both deprivation and excess sleep

but this mechanism is not fully understood, despite being a frequent

complaint of migraine and TTH patients

. On the other hand, res-

torative sleep with sufcient sleep hours works as a relief factor for

headache attacks.

Almost half of the population has some sleep disorder, mainly

insomnia

. Sleep disorders represent an important public health

problem in the world and are comorbidities of primary headaches.

In contrast, primary headaches have great social impact and risk

of chronication.

10,11

Despite the social impact, headache attacks triggered by sleep de-

privation in patients with migraine or TTH have not been sufciently

studied. This is the rst Brazilian population study on headache

triggered by sleep deprivation.

Patients and methods

Study design and patients

A prospective, cross-sectional, group comparative study was conduc-A prospective, cross-sectional, group comparative study was conduc-

ted on a non-random and convenience sampling which was selected ted on a non-random and convenience sampling which was selected

from night workers of a public hospital and invited to participate in from night workers of a public hospital and invited to participate in

this research. The sample consisted of 71 night workers diagnosed this research. The sample consisted of 71 night workers diagnosed

with primary headaches according to the ICHD-3 criteria.with primary headaches according to the ICHD-3 criteria.

1212

Inclusion and exclusion criteriaInclusion and exclusion criteria

The study included night workers of a public hospital, aged 18 to 50 The study included night workers of a public hospital, aged 18 to 50

years diagnosed with primary headaches according to the ICHD-3 years diagnosed with primary headaches according to the ICHD-3

criteriacriteria

1212

who agreed to undergo an interview. Those who reported who agreed to undergo an interview. Those who reported

daily or almost daily headache, no headache in the last 12 months, daily or almost daily headache, no headache in the last 12 months,

association of two or more primary headaches, concomitantly or at association of two or more primary headaches, concomitantly or at

different times, secondary headaches, and pregnant women weredifferent times, secondary headaches, and pregnant women were

excluded.excluded.

Data collection

After fulfilling the inclusion and exclusion criteria, a structured

interview was conducted, based on a questionnaire to diagnose the

presence of headache on the day after night shift. The number of

times the worker slept at work and the number of hours he/she slept

at home and at work were investigated.

Statistical analysis

Organized the information in a database, the Statistical Package

for Social Sciences (SPSS™) version 22.0 was used for statistical

analysis. The chi-square test with Yates correction, Student’s t-test and

Fisher’s exact test were used for the difference of means of unpaired

samples, with a signicance level of 0.05.

Ethical aspects

This study was approved by the Ethics in Research Involving Human

Subjects Committee at the Federal University of Piauí, protocol

number 3,305,167 and the National Ethics in Research System,

registry number 08850918.0.0000.5214, on May 6, 2019. Data

were collected from May to June 2019 and all volunteers signed the

Informed Consent Form.

Results

Seventy-one night workers, aged 36.7±7.7 years, ranging from 22

to 50 years, were investigated, of which 50 (70.4%) were women,

corresponding to the sex ratio of 1:4.9 male/female. After headache

diagnosis, it was found that 59 (83.1%) workers had migraine and

12 (16.9%) met the diagnostic criteria for TTH. Migraine affected

workers aged 36.0±7.6 years, while in TTH, the age was 35.8±8.8

years (p=0.935) (Table 1).

Table 1. Distribution of sex and age according to diagnosis of 59 migraine

patients and 12 with tension-type headache

Variables Diagnosis Migraine TTH

Gender

Female (n; %) 45 (76.3) 5 (41.7) 0.032*

Male (n; %) 14 (23.7) 7 (58.3)

Age (years)

Mean (SD) 36.0 (7.6) 35.8 (8.8) 0.935**

Variation 23-50 22-50

Note: TTH - tension-type headache; SD - standard deviation; * - p-value

based on Fisher's exact test for mean difference of unpaired samples. ** - p

value based on Student's t-test for mean differences in unpaired samples

The number of monthly night shifts was greater than 10 in 50.8%

of migraine patients and 58.3% of patients with TTH (p=0.876).

We found that 91.5% of migraine patients and 83.3% of patients

with TTH slept six or more hours a night when they were at home,

but when on duty, 100% slept four hours or less a night (Table 2).

ASAA

Rosado MSV, Silva-Néto RN.

Headache triggered by sleep deprivation an observational study

Table 2. Distribution of the number of monthly night shifts, hours the worker

slept at home and night work, and the presence of headache the day after

night shift in 59 migraine patients and 12 with tension-type headache

Variables

Diagnosis

p-value

Migraine TTH

Monthly night shifts 0.876*

< 10 29 (49.5) 5 (41.7)

≥ 10 30 (50.8) 7 (58.3)

Number of hours he/she slept at home 0.592**

< 6 5 (8.5) 2 (16.7)

≥ 6 54 (91.5) 10 (83.3)

Number of hours he/she slept at work 0.717**

< 3 15 (25.4) 2 (16.6)

3 or 4 44 (74.6) 10 (83.3)

Presence of headache the day after

night shift

0.005**

Yes 49 (83.1) 5 (41.7)

No 10 (16.9) 7 (58.3)

It was found that 83.1% (49/59) of migraine patients and 41.7%

(5/12) of those with TTH presented headache the next day after night

shift. These differences were signicant (p = 0.005) (Tables 2 and 3).

Table 3. Distribution of the frequency of headache triggered by sleep depri-

vation in 59 migraine patients and 12 with tension-type headache

Variables

Diagnosis

p-value

Migraine TTH

Never 10 (16.9) 7 (58.3) 0.005*

Rarely 27 (45.8) 3 (25.0)

Most of the time 20 (33.9) 2 (16.7)

Every times 2 (3.4) 0 (0.0)

Note: TTH - tension-type headache; p value calculated by Fisher's exact test, comparing:

* no versus ≥ rarely, most of the time or every time.

Discussion

In this study, two groups of night workers diagnosed with migraine or

TTH were compared by the relationship between headache and sleep

deprivation. Therefore, in order to obtain valid and consistent data,

a correct diagnosis was established for each headache, according

to the criteria of ICHD-3.

Primary headaches, especially migraine and TTH, are the main diag-

noses found in hospitals and clinics worldwide.

13-15

These headaches

have signicant morbidity and socioeconomic effect

, demonstrating

a great importance for public health as it affects patients at the most

productive age of their lives, between 30 and 40 years of age

, as

noted in this study.

Sleep deprivation has always been known as one of the factors that

trigger a headache attack in migraine patients

, but a community

study in Malaysia has shown that sleep deprivation triggers headache

attacks in both migraine and TTH patients.

Many patients have both migraine and TTH. In this case, the dif-

ferentiation between these two primary headaches, especially in

mild forms, represents a diagnostic challenge. Some factors serve

to differentiate migraine from TTH, such as headache triggered by

odors that occurs only in migraine patients.

In our study, headache

triggered by sleep deprivation was more prevalent in migraine

patients, with statistical signicance, and could be a differentiating

factor between these headaches.

Sleep deprivation triggers headache attacks in the general popula-

tion, but mainly in people who work at night. Some of these workers

sleep a few hours or sometimes do not have time to sleep. In addition,

those who sleep a few hours do so in a different bed than the one

they usually sleep on.

There was a higher percentage of migraine patients who had head-

ache triggered by sleep deprivation. According to ICHD-3, in mi-

graine, headache attacks are more severe than in TTH12 and this has

a negative impact with a signicant socioeconomic effect due to the

greater probability of missing work and having more days lost.

10,11,16

The brain mechanisms underlying altered pain processing after sleep

deprivation are unknown. However, it is believed that inadequate

sleep or even total sleep deprivation may reduce pain thresholds

and amplify pain reactivity in the primary somatosensory cortex.

20,21

Conclusion

Headache triggered by sleep deprivation is highly prevalent, pre-

dominating in migraine patients.

Funding:

This research received no specic grant from any funding agency

in the public, commercial, or not-forprot sectors.

Conflict of Interest:

There is no conict of interest.

Matheus Saraiva Valente Rosado

https://orcid.org/0000-0001-9426-0425

Raimundo Silva-Néto

https://orcid.org/0000-0002-2343-9679

References

1. Fukui PT, Gonçalves TRT, Strabelli CG, et al. Trigger factors in

migraine patients. Arq Neuropsiquiatr. 2008; 66: 494–499.

2. Kelman L. The triggers or precipitants of the acute migraine

attack. Cephalalgia. 2007; 27: 394–402.

3. Wang J, Huang Q, Li N, et al. Triggers of migraine and tension-

-type headache in China: a clinic-based survey. Eur J Neurol.

2013; 20: 689–696.

4. Andress-Rothrock D, King W, Rothrock J. An analysis of migraine

triggers in a clinic-based population. Headache. 2010; 50:

1366 –1370.

5. Carod-Artal FJ, Ezpeleta D, Martín-Barriga ML, et al. Triggers,

symptoms, and treatment in two populations of migraneurs in

Brazil and Spain. a cross-cultural study. J Neurol Sci. 2011;

304: 25–28.

ASAA

Rosado MSV, Silva-Néto RN.

Headache triggered by sleep deprivation an observational study

6. Bruni, O, Russo PM, Ferri R, et al. Relationships between hea-

dache and sleep in a non-clinical population of children and

adolescents. Sleep Medicine. 2008; 9: 542–548.

7. Engstrøm M, Hagen K, Bjørk MH, et al. Sleep quality, arousal

and pain thresholds in migraineurs: A blinded controlled poly-

somnographic study. J Headache Pain. 2013; 14: 12.

8. Yagihara F, Lucchesi LM, Smith AKA, et al. Primary headaches

and their relationship with sleep. Sleep Science. 2012; 5: 28–32.

9. Ferré-Masó A, Rodriguez-Ulecia I, García-Gurtubay I. Dieren-

tial diagnosis of insomnia from other comorbid primary sleep

disorders. Aten Primaria. 2020. pii: S0212-6567(20)30005-6.

[Epub ahead of print].

10. Guglielmetti M, Raggi A, Ornello R, et al. The clinical and

public health implications and risks of widening the denition

of chronic migraine. Cephalalgia. 2019:15:333102419895777.

[Epub ahead of print].

11. Sanya EO, Desalu OO, Aderibigbe SA, et al. Prevalence and

clinical characteristics of headaches among undergraduate

students in three tertiary institutions in Ilorin, Nigeria. Niger J

Clin Pract. 2017; 20: 1411–1416.

12. Headache Classication Subcommittee of the International

Headache Society. The International Classication of Headache

Disorders, 3rd Edition. Cephalalgia. 2018; 38: 1– 211.

13. Kim SK, Moon HS, Cha MJ, et al. Prevalence and features

of a probable diagnosis in rst-visit headache patients ba

sed on the criteria of the third beta edition of the internatio-

nal classication of headache disorders: a prospective. Cross

sectional multicenter study. Headache. 2016; 56: 267–75.

14. Tai ML, Jivanadham JS, Tan CT, et al. Primary headache in the

elderly in South-East Asia. J Headache Pain. 2012; 13: 291–7.

15. Wöber C, Wöber-Bingöl C. Triggers of migraine and tension-

-type headache. Handb Clin Neurol. 2010; 97: 161–72.

16. Kahriman A, Zhu S. Migraine and Tension-Type Headache.

Semin Neurol. 2018; 38: 608-618.

17. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability

(YLDs) for 1160 sequelae of 289 diseases and injuries 1990-

2010: A systematic analysis for the global burden of disease

study 2010. Lancet. 2012; 380: 2163–2196.

18. Alders EEA, Hentzen A, Tan CT. A community-based prevalence

study on headache in Malaysia. Headache. 1996; 36: 379–84.

19. Silva-Néto RP, Peres MF, Valença MM. Accuracy of osmophobia

in the dierential diagnosis between migraine and tensiontype

headache. J Neurol Sci. 2014; 339: 118– 122.

20. Krause AJ, Prather AA, Wager TD, et al. The pain of sleep

loss: A brain characterization in humans. J Neurosci. 2019;

39: 2291–2300.

21. Engstrøm M, Hagen K, Bjørk MH, . Sleep quality and arousal

in migraine and tension type headache: the headache sleep

study. Acta Neurol Scand 2014; 129: 47– 54.