Excessive Daytime Sleepiness Linked to Headache Frequency But Not Severity

Teenage girl sleeping at a table
Teenage girl sleeping at a table
There is an established link between excessive daytime sleepiness and headache frequency.

An association was established between excessive daytime sleepiness (EDS) and a high frequency of headaches, but not between EDS and chronic migraine or chronic tension-type headache (CTTH). The results were published in Cephalalgia.1

Espen S. Kristoffersen, PhD from Akershus University Hospital in Norway and colleagues conducted a cross-sectional survey of 30,000 people age 30 to 44 from Akershus County via a mail questionnaire designed to determine the presence of possible chronic headache (defined as ≥15 headache days in the previous month and/or ≥180 headache days in the previous year) in the local population. After further screening, including an interview with 2 headache specialists, 323 eligible individuals were selected to participate in the study (n=288 with CTTH, n=35 with chronic migraine; 78% women; mean age, 38.1).

The participants completed the Epworth Sleepiness Scale questionnaire, which assesses excessive daytime sleepiness by asking respondents to rate their likelihood of falling asleep while engaged in 8 different activities on a scale of 0 to 3.2 The ESS scores were dichotomized into scores ≤10 and >10, which are considered clinically significant EDS. Participants also provided information regarding their sociodemographic status, level of disability (with the Migraine Disability Assessment [MIDAS]), and emotional distress (using the Hopkins Symptom Checklist-25 [HSCL-25]). Severe disability due to migraine (ie, MIDAS score >20) was reported by 49% and 78% of study participants with CTTH and chronic migraine, respectively, and emotional distress by 56% and 52%, respectively.

The overall prevalence of EDS was 21.1% (95% Cl, 17.0-25.8) in patients with chronic migraine and CTTH, and appeared higher in men than in women; 22.5% (95% Cl, 14.4-33.5) vs 20.6% (95% Cl, 16.1-26.1), respectively. The prevalence of EDS in chronic migraine was 22.9% (95% Cl, 12.1-39.0) overall; 30% (95% Cl, 10.8-60.3%) in men, and 20% (95% Cl, 8.9-39.1) in women. The prevalence of EDS in CTTH was 20.8% (95% Cl, 16.5-25.9) overall; 21.3% (95% Cl, 12.9-33.1) in men, and 20.7% (95% Cl, 15.9-26.4) in women.

Patients’ MIDAS or HSCL-25 scores were not associated with EDS; nor were age, gender, or medication overuse. Headache days >80 in the past 3 months was associated with EDS (OR 2.03; 95% Cl, 1.11-3.73, P =.022).

“Our findings that increased frequency, but not type of headache, increased EDS may contribute to the hypothesis that it is the burden of complex pain rather than the specific condition that is associated with EDS,” concluded the investigators.

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Summary and Clinical Applicability

  • An association between excessive daytime sleepiness and high headache frequency was established
  • No association was found between excessive daytime sleepiness and chronic migraine or chronic tension-type headache
  • Physicians should evaluate sleep disturbances in patients presenting with primary chronic headache


  • The number of variables that could be analyzed as potential confounders were limited by the small sample size
  • Many variables were dichotomized for use in the analyses
  • “The cross-sectional design in the present study does not permit any conclusions about causality in the relationship between [chronic migraine]/CTTH and EDS.”


  1. Kristoffersen ES, Stavem K, Lundqvist C, Russell MB. Excessive daytime sleepiness in chronic migraine and chronic tension-type headache from the general population [published online July 10, 2917]. Cephalalgia. doi:10.1177/0333102417721133
  2. Grande RB, Aaseth K, Gulbrandsen P, et al. Prevalence of primary chronic headache in a population-based sample of 30- to 44-year-old persons. The Akershus study of chronic headache. Neuroepidemiology 2008;30:76-83.

This article originally appeared on Neurology Advisor