Many patients consider poor sleep a major trigger for their migraines, which affects 12% of adults and is the second leading cause of disability worldwide. Although poor sleep can trigger migraines, the timing of migraine onset is usually the day after, rather than the next morning, according to study results published in Neurology.

A total of 98 adults with episodic migraine, defined as at least 2 migraines per month during the last 3 months, completed an electronic sleep diary (Consensus Sleep Diary). Every morning, patients answered questions on the timing of sleep, quality of sleep, awakenings, and medications taken. Patients also wore an actigraph on their non-dominant wrist (Actiwatch Spectrum) for 24 hours a day for 6 weeks. A trained technician measured sleep efficacy and onset based on the data collected from the actigraph.

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As part of their sleep diary, patients reported the presence of headache, time of onset, and whether the headache was ongoing. When the headache resolved, the patients recorded information regarding the time of resolution, duration, pain intensity, use of headache medications, and if their headache was “similar to previous or usual migraines.” When headache onset was reported within 1 calendar day of a prior headache’s resolution it was considered a relapse.

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Other risk factors for migraines, including alcohol use, menstrual cycle, amount of caffeinated beverages consumed, and the minutes of moderate and vigorous physical activity that day were also recorded. Patients also recorded their level of stress.

At the beginning of the trial, over 68% of patients attributed too little sleep as a trigger for their migraines and approximately one-quarter of patients used daily migraine prophylactic medication.

During the 6-week assessment, patients reported a total of 870 headaches with an average of 8.4 headaches per patient. The average diary-reported total sleep time was 7.7 hours per night, with low levels of reported sleep disturbance as noted by low wake after sleep onset (WASO) and high sleep efficiency. The average sleep duration estimated by actigraphy was 7.3 hours.

The researchers found that in the day immediately following the sleep period (day 0), there was no association between diary-based sleep characteristics and headache. Of interest, “there was a 36% lower odds of headache following a night of actigraphy-based high WASO and low sleep efficiency. No associations were found between actigraph-estimated shorter or longer sleep duration and headache [on day 0],” noted the researchers.

“However, nightly lower sleep efficiency was associated with subsequent headache not on the day immediately following sleep, but on the following day,” they said. Diary-based low sleep efficiency was associated with 39% higher odds of headache on the following day (day 1); no other statistically significant associations were observed. Higher odds of headache on day 1 was also found following a night of actigraph-assessed low sleep efficiency.

“Our findings provide new data showing that while nightly short sleep duration does not appear to trigger migraine, variability in sleep fragmentation temporally precedes migraine onset,” the investigators concluded.


Bertisch SM, Li W, Buettner C, et al. Nightly sleep duration, fragmentation, and quality and daily risk of migraine [published online December 16, 2019]. Neurology. doi:10.1212/WNL.0000000000008740

This article originally appeared on Neurology Advisor