Association of excessive daytime sleepiness with migraine and headache frequency in the general population
Stavem et al. The Journal of Headache and Pain
Association of excessive daytime sleepiness with migraine and headache frequency in the general population
Knut Stavem 0 1
Håvard Anton Kristiansen 0 1
Espen Saxhaug Kristoffersen 1
Kari Jorunn Kvaerner 1
Michael Bjørn Russell 0 1
0 Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo , Lørenskog , Norway
1 Head and Neck Research Group, Research Centre, Akershus University Hospital , Lørenskog , Norway
Background: Some previous studies have postulated an association between migraine and excessive daytime sleepiness (EDS). This study evaluated the association of EDS with migraine and headache frequency in a general population, after adjusting for potential confounding variables. Methods: The study was a postal survey of a random age and gender-stratified sample of 40,000 persons aged 20 to 80 years old drawn by the National Population Register in Norway. The questionnaire included questions about migraine, headache, the Epworth sleepiness scale (ESS) and various comorbidities. EDS was defined as ESS > 10. The association of EDS and migraine/headache were analysed by bivariate and multivariable logistic regression analyses. Results: A total of 21,177 persons responded to the ESS and were included in the analyses. The odds ratio (OR) for EDS was increased for migraineurs (1.42 (95% CI 1.31─1.54), p < 0.001) compared to non-migraineurs; however, this finding was not significant after adjustment for a number of possible confounders. EDS increased with increasing headache frequency, with an OR of 2.74 (95% CI 2.05─3.65), p < 0.001) for those with headache on >179 days per year compared to those without headache in multivariable analysis. Conclusions: In a general population, the odds for EDS increased significantly with the headache frequency, irrespective of migraine status. EDS was not associated with reported migraine in multivariable analysis.
Epidemiology; Excessive daytime sleepiness; Headache; Migraine
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Background
Headache is the most common type of pain experienced
by man, but receives little attention, possibly due to the
often mild symptoms, and because most people rarely
consult their physician due to headache [1]. Almost
everyone experience tension-type headache once in a
while, and migraine affects 10–20% of the general
population [2, 3]. About 3% of the world population have
chronic headache, i.e. mainly chronic tension-type
headache or chronic migraine [4, 5].
Persons with headache and/or migraine often complain
of sleepiness, a symptom with high clinical and public
health importance due to increased risk for accidents,
decreased productivity and impaired quality of life [6–9].
Excessive daytime sleepiness (EDS) is experienced by
8─30% of the general population [10–13]. Despite the
considerable burden of EDS, it is still under-reported,
under-diagnosed and under-treated among those with
chronic pain as well as in the general population [14–16].
Some clinic-based [17–20] or population-based [21]
studies have proposed an association between migraine
and EDS. Recently a large population-based study
reported an association between migraine and EDS in
bivariate analysis, but this association was weakened in
multivariable analysis and became non-significant when
adjusting for anxiety, depression, sleep duration and a
score for sleep quality [22]. Moreover, whether EDS is
associated with headache frequency in migraineurs
varies between studies [21, 22].
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
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the Creative Commons license, and indicate if changes were made.
The present study aimed to investigate the association
of EDS with migraine and headache frequency in an age
and gender-stratified general population sample, after
adjusting for possible confounders.
Methods
Study design and sample
An age and gender-stratified random sample of 40,000
persons aged 20─80 years old were drawn by the
National Population Register of Statistics Norway. Each of
the ages 30, 35, 40, 45, 50, 55 and 60 years included
2,000 persons of each gender, while the remaining ages
included 1,000 persons of each gender. The participants
were residing in Akershus, Hedmark or Oppland
County. The sample size was reduced to 38,871 because
of error in the address list (n = 1,024), multi-handicap (n
= 4), dementia (n = 23), insufficient Norwegian language
skills (n = 3) and deceased (n = 75). The three counties
have both rural and urban areas, and Akershus County
is situated in close proximity to Oslo. Details of the
study have previously been presented [23].
Postal survey
All participants received a mailed questionnaire with a
standard l (...truncated)