Association of excessive daytime sleepiness with migraine and headache frequency in the general population

The Journal of Headache and Pain, Mar 2017

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.

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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 - 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 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to 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)


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Knut Stavem, Håvard Anton Kristiansen, Espen Saxhaug Kristoffersen, Kari Jorunn Kværner, Michael Bjørn Russell. Association of excessive daytime sleepiness with migraine and headache frequency in the general population, The Journal of Headache and Pain, 2017, pp. 35, Volume 18, Issue 1, DOI: 10.1186/s10194-017-0743-0