Sleep and Neurology: Headache
For this Sleep Science Friday, we feature another chapter from the ESRS Sleep Medicine Textbook 2nd edition, “Headache” in the Sleep and Neurology section.
The chapter provides a clear overview of the bidirectional relationship between sleep and headache disorders, focusing on migraine, tension-type headache (TTH), and cluster headache (CH). Sleep disturbances are common in these conditions, but headaches themselves may also disrupt sleep, contributing to fatigue and daytime sleepiness.
For migraine, sleep deprivation and insomnia are established risk factors, while chronic headache increases the likelihood of developing insomnia—highlighting a mutual reinforcement between pain and poor sleep. Obstructive sleep apnoea (OSA) is linked to non-specific morning headaches and is also observed in cluster headache.
Although few headache types are defined by sleep-specific patterns, sleep often plays a modulatory role. For many patients, episodes of sleep help alleviate symptoms. The chapter also highlights therapeutic strategies: CBT-I shows promise across headache types, and addressing OSA may reduce comorbid headache burden. In cases with circadian timing, chrono-therapeutic approaches may be relevant.
Despite their high prevalence, the overlap between sleep and headache remains under-recognised and merits further attention in both research and clinical practice.
Keywords:
cluster headache, comorbidity, epidemiology, hypnic headache, insomnia, management, migraine, obstructive sleep apnea (OSA), pathophysiology, sleep deprivation, tension-type headache
Key Points:
- Sleep disorders and headaches are bidirectionally connected to each other.
- Patients with chronic migraines or tension-type headaches (TTH) are at a significantly increased risk of developing insomnia (odds ratio [OR] 1.4-2.6 or OR 1.8).
- Cluster headache (CH) types of headache attacks are often linked to sleep. Sleep-related breathing disorders often occur in CH.
- A changing sleep-wake rhythm, sleep deprivation and insomnia are risk factors for the occurrence of migraine attacks. Sleep episodes are often helpful in alleviating migraine attacks.
- … you can read all key points and the full M.6 Headache chapter in the ESRS Sleep Medicine Textbook – order it here.
Chapter written by:
Ulf Kallweit and Ramin Khatami
Recent publications from ESRS members
- McNicholas WT, van der Werf YD, Hartley S, Philip P; study collaborators in the Assembly of National Sleep Societies and other National Representatives.(2025), Implementation of European national driving regulations for obstructive sleep apnoea: challenges and recommendations. Eur Respir J.
- Peng C, Wang K, Wang J, Wassing R, Eickhoff SB, Tahmasian M, Chen (2025) J. Neural correlates of insomnia with depression and anxiety from a neuroimaging perspective: A systematic review. Sleep Med Rev.
- Akradi M, Farzane-Daghigh T, Ebneabbasi A, Bi H, Drzezga A, Mander BA, Eickhoff SB, Tahmasian M; (2025) Alzheimer’s Disease Neuroimaging Initiative. How is self-reported sleep-disordered breathing linked with biomarkers of Alzheimer’s disease? Neurobiol Aging.
- Samea F, Mortazavi N, Reimann GM, Ebneabbasi A, Zarei M, Khazaie H, Goldstein-Piekarski AN, Spiegelhalder K, Baglioni C, Sepehry AA, Tahmasian M. (2025). Insomnia and emotion dysregulation: a meta-analytical perspective integrating regulatory strategies and dispositional difficulties. Sleep Med Rev.
- Carpi M, Szkody EM, Marques DR.(2025) One Single Session to Sleep Them All? The Potential of Single-Session Interventions for Insomnia. J Sleep Res.
- Marques D. R. (2025). The quest for “good sleepers”: A scientific and societal challenge. Behavioral Sleep Medicine