Comparison of Sleep, Headache-Related Disability, and Psychological Functioning among Adolescents with Continuous Headache to Youth with Non-Continuous Migraine

Editor’s note: The research described below comes from a recipient of a 2023 MSC Travel Grant supporting travel to the 65th Annual Scientific Meeting of the American Headache Society. These grants reimburse travel expenses for those who have had their abstract for a presentation or poster accepted at a meeting.

By Elizabeth Adam, research assistant, Wake Forest University, US.

What is the research gap that your study addresses?

Continuous headache, or headache that is always present, is a clinical phenomenon associated with significant functional impairment among children and adolescents. This condition is rare and generally more treatment-resistant than primary headache disorders, such as non-continuous migraine, and clinical research is limited on children and adolescents with continuous headache. Thus, this study addresses the difference in sleep behavior between adolescents with continuous headache and youth with non-continuous migraine. Determining differences in sleep behavior between these two groups could help contribute to potential treatment interventions for patients with continuous headache.

What is your research hypothesis?

Youth with continuous headache may be particularly vulnerable to sleep difficulties because of the consistent nature of their condition. Sleep problems are common and disabling among youth with migraine, although little is known about the sleep patterns of adolescents with continuous headache.

What methodology did you use to address your research hypothesis?

Twenty-six youth (ages 12-18) with continuous headache were recruited from the Cincinnati Children’s Hospital Headache Center (CCH-HC). These youth presented with an “always”-present headache for at least 1 month and received an ICHD-3 diagnosis of chronic migraine, chronic tension-type or new daily persistent headache. Sleep-wake behavior was assessed using the Adolescent Sleep Wake Scale (ASWS). Three ASWS subscale scores (Falling Asleep and Re-Initiating Sleep, Return to Wakefulness, and Going to Bed) were compared to those of 26 age- and gender-matched youth with non-continuous migraine who were recruited separately in the CCH-HC. ASWS subscale scores of youth with continuous headache and non-continuous migraine were also compared to published data on youth without chronic pain for this sleep measure. Associations were also examined among ASWS sub-scales and 1) youth headache-related disability as measured via the PedMIDAS and 2) anxiety and depressive symptoms measured using PROMIS short-form scales.

What are the main results of your study?

Among all groups, scores on each of the ASWS sub-scales were considerably lower than what has been reported among youth without chronic pain conditions, indicating poorer sleep quality in each domain. Youth with continuous headache reported significantly greater headache-related disability (t[50]= 3.88, p<0.001), anxiety symptoms (t[49]= 4.19, p<0.001) and depressive symptoms (t[49]= 3.94, p<0.001) relative to the comparison sample of youth with non-continuous migraine. In the combined sample, all ASWS subscale scores were negatively correlated with depressive symptoms (p range= -0.34 – -0.36, p’s<0.05), while difficulties with falling asleep and reinitiating sleep were significantly associated with anxiety symptoms (p=-0.39, p<0.01).

What conclusions did you reach based on your results?

Sleep disturbances are common among youth with and without continuous headache. Adolescents with continuous headache may be particularly at risk for sleep disturbances given their vulnerability to heightened anxiety and depressive symptoms. Additional research is needed to identify optimal strategies for improving sleep intervention for youth with continuous headache.

What are the limitations of your study?

This study was composed of patients recruited solely from the Cincinnati Children’s Hospital Headache Center. Although Cincinnati Children’s Hospital Medical Center has both a large regional and national presence, this study did not incorporate patients from other headache centers.

What is the relevance of your study to migraine?

Adolescents with continuous headache and non-continuous migraine reported comparable degrees of sleep disturbance, but youth with continuous headache may be particularly vulnerable to sleep difficulties due to experiencing greater anxiety and depressive symptoms. Adolescents who experience headache disorders, such as migraine and continuous headache, are at risk for sleep difficulties. By identifying specific sleep difficulties, treatment interventions for these conditions can incorporate sleep behavior plans.