What’s Behind that Morning Migraine? Community-Based Study Points to Differences in Perceived Sleep Quality, Energy on the Previous Day

Posted on February 8th, 2024 by Dr. Monica M. Bertagnolli

Headaches are the most common form of pain and a major reason people miss work or school. Recurrent attacks of migraine headaches can be especially debilitating, involving moderate to severe throbbing and pulsating pain on one side of the head that sometimes lasts for days. Migraines and severe headaches affect about 1 in 5 women and about 1 in 10 men, making them one of the most prevalent of all neurological disorders.¹ And yet there’s still a lot we don’t know about what causes headaches or how to predict when one is about to strike.

Now a new NIH-led study reported in the journal Neurology has some important insight.² One of the things I especially appreciate about this new work is that it was conducted in a community setting rather than through a specialty clinic, with people tracking their own headache symptoms, sleep, mood, and more on a mobile phone app while they went about their daily lives. It means that the findings are extremely relevant to the average migraine sufferer who shows up in a primary care doctor’s office looking for help for their recurrent headaches.

The study, led by Kathleen Merikangas at NIH’s National Institute of Mental Health, Bethesda, MD, is part of a larger, community-based Family Study of Affective and Anxiety Spectrum Disorders. This ongoing study enrolls volunteers from the greater Washington, D.C., area with a range of disorders, including bipolar disorders, major depression, anxiety disorders, sleep disorders, and migraine along with their immediate family members. It also includes people with none of these disorders who serve as a control group. The goal is to learn more about the frequency of mood and other mental and physical disorders in families and how often they co-occur. This information can provide insight into the nature and causes for all these conditions.

While there will be much more to come from this ambitious work, the primary aim for this latest study was to look for links between a person’s perceived mood, sleep, energy, and stress and their likelihood for developing a headache. The study’s 477 participants, aged 7 to 84, included people with and without migraines who were also assessed for mood, anxiety, sleep disorders and other physical conditions. Women accounted for 291 of the study’s participants. Each were asked to track their emotional states, including anxiousness, mood, energy, stress, and headaches four times each day for two weeks. Each morning, they also reported on their sleep the night before.

The data showed that people with a morning migraine reported poorer quality sleep the night before. They also reported lower energy the day before. Interestingly, those factors didn’t lead to an increased risk of headaches in the afternoon or evening. Afternoon or evening headaches were more often preceded by higher stress levels or having higher-than-average energy the day before.

More specifically, people with poorer perceived sleep quality on average had a 22 percent greater chance for a headache attack the next morning. A decrease in the self-reported usual quality of sleep was also associated with an 18 percent increased chance of a headache the next morning. Similarly, a drop in the usual level of energy on the prior day was associated with a 16 percent greater chance of headache the next morning. In contrast, greater average levels of stress and substantially higher energy than usual the day before was associated with a 17 percent increased chance of headache later the next day.

Surprisingly, the study didn’t find any connection between feeling anxious or depressed with headaches on the next day after considering energy and sleep. However, Merikangas emphasizes that participants’ perceived differences in energy and sleep may not reflect objective measures of sleep patterns or energy, suggesting that the connection may still be based on changes in a person’s feelings about their underlying physical or emotional state in complex ways.

The findings suggest that changes in the body and brain are already taking place before a person first feels a headache, suggesting it may be possible to predict and prevent migraines or other headaches. It also adds to evidence for the usefulness of diaries or apps for headache sufferers to track their sleep, health, behavioral, and emotional states in real time to better understand and manage headache pain. Meanwhile, the researchers report that they’re continuing to explore other factors that may precede and trigger headaches, including dietary factors, changes in a person’s physiology such as stress hormone levels, and environmental factors, including weather, seasonal changes, and geography.

References:

[1] American Headache Society. The Prevalence of Migraine and Severe Headache.

[2] Lateef TM, et al. Association Between Electronic Diary-Rated Sleep, Mood, Energy, and Stress With Incident Headache in a Community-Based Sample. Neurology. DOI: 10.1212/WNL.0000000000208102. (2024).

NIH Support: National Institute of Mental Health