The association between sleep duration with migraine frequency, disability and perceived stress in the Headache Assessment via a Digital platform in United States (HeAD-US) Study

Study objectivesTo examine the association between self-reported sleep duration on migraine frequency and disability MethodsWe conducted a cross-sectional analysis from the Headache Assessment via a Digital Platform in the United States (HeAD-US) Study, a survey of adult users of the Migraine Buddy App. Participants reported average nightly sleep duration, headache features and completed the Perceived Stress Scale-4, the Migraine Disability Assessment Test and the Patient Health Questionnaire-4 for anxiety and depression. Sleep duration was categorized as short ([≤]6 hours), normal (7-9 hours) and long ([≥]10 hours). Migraine diagnosis adhered to the International Classification of Headache Disorders-3. ResultsThe 6267 participants had a mean age of 41.5{+/-}13.1 years, were 90.8% female and had a mean sleep duration of 6.92 hours (SD 1.32, range 2-15). Compared to normal sleepers, short sleepers had higher risk of more frequent monthly headache days (RR = 1.128, 95% CI: 1.067-1.192) and disability (RR = 1.167, 95% CI: 1.106-1.231). Long sleepers had greater risk of more frequent monthly headache days (RR = 1.274, 95% CI: 1.049-1.464) and disability (RR = 1.699, 95% CI: 1.446-1.997). In mediation models, short sleep was linked to approximately 1.3 extra monthly headache days and long sleep to approximately 3 extra days, with stress accounting for only part of these effects. ConclusionsUnhealthy sleep duration, particularly long sleep, is associated with greater migraine burden, characterized by increased headache frequency and disability. Perceived stress partly mediated but did not fully account for these relationships. Statement of significanceThis study is the first to comprehensively report on associations of unhealthy sleep duration with migraine burden in a large population of adults with migraine. Adults who report sleeping too little (6 hours ore less per night) or too much (10 hours or more per night) on average have more frequent and disabling migraine. Short sleep was linked to approximately 1.3 extra monthly headache days and long sleep to 3 extra days, with stress accounting only for part of these effects.