For patients with migraine, poor sleep quality contributes to increased migraine risk and migraine pain, as well as reduced QOL and mental health.


Migraine has been shown to significantly reduce HRQOL and has substantial effects on daily activities, direct medical costs, and the prevalence of comorbidities. Early detection of factors strongly associated with migraine is critical to reducing the burden of disease, with important implications for prevention, treatment, and prognosis.

Studies have also shown that migraine is associated with a wide range of sleep disturbances. “Poor sleep quality is one of the most common sleep disturbances in patients with migraine and can have an impact on migraine chronicity,” says Zunjing Liu. However, data on the associations between sleep quality and the risk for developing migraine have not been fully elucidated in clinical research.

The Pittsburgh Sleep Quality Index (PSQI) is a self-reported sleep quality questionnaire that assesses sleep quality over the past month and can be used to assess poor sleep quality in patients with migraine. Considering previously documented relationships between sleep and migraine in published research, the PSQI score may be useful as a predictor of migraine. However, few analyses have reported on the predictive value of the PSQI score for migraine.

For a study published in Frontiers in Neurology, Liu and colleagues systematically explored the relationship between sleep quality and risks for developing migraine; they also reviewed gender and age differences. They investigated associations between sleep quality and total pain burden, severity, disability, headache impact, QOL, anxiety, and depression. Sleep quality was assessed using the PSQI. In total, 134 patients with migraine and 70 sex- and age-matched healthy controls were included in the analysis.

Poor Sleep More Common in Patients With Migraine

According to the results, the prevalence of poor sleep quality in patients with migraine was significantly higher than in those without the headache disorder. “About two-thirds of patients with migraine had poor sleep quality, and poor sleep quality was significantly associated with an increased risk for migraine,” Liu says.

After adjusting for different confounding factors, the risk for developing migraine in those with poor sleep quality was still 3.981 times higher than that of patients with good sleep quality. Additionally, the authors noted that PSQI scores had good diagnostic specificity for migraine.

In a subgroup analysis, investigators observed significant additive interactions between poor sleep quality and the risk of migraine based on gender, age, and education level. Stronger correlations were found in women, patients aged 35  and older, and in those with lower education levels (Table). Furthermore, a multivariate linear regression analysis showed that poor sleep quality was significantly and independently associated with the total pain burden, severity, headache impact, QOL, anxiety, and depression in patients with migraine.

Incorporating Sleep Quality in Migraine Treatment

The associations between sleep quality and migraine-related burdens are important topics that are worthy of greater attention, according to Liu. The current study showed that poor sleep quality was significantly and independently associated with a higher risk of developing migraine and migraine-related burdens. This information can be used to develop new interventions to improve the prevention and treatment of migraine-related burdens, according to Liu and colleagues.

The authors also recommend using PSQI assessments when evaluating patients with migraine.

“The PSQI tool is convenient, practical, and accurate for assessing sleep quality,” Liu says. “It can also guide efforts for early prevention and sleep interventions when managing patients with migraine.”

Since the PSQI score had good predictive accuracy and diagnostic specificity for migraine, it may be a potential predictor for migraine, but this requires further validation in future research.

The study team hopes to expand the sample size in future research to explore the effect of preventive treatment on associations between sleep quality and migraine. Studies are also needed to explore if associations between sleep quality and migraine are different based on whether patients receive preventive migraine treatments.