Migraine and sleep are strongly interconnected, study finds
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Sleep problems are significantly more common among people with migraine than among those without headaches. People with migraine also tend to have a later chronotype, meaning they tend to fall asleep and wake up later and are most active later in the day.
These findings come from the largest nationwide Polish study, involving more than 5,300 adults and conducted by a team of Wrocław researchers led by Marta Waliszewska-Prosół, MD, Ph.D. The researchers analyzed data from 5,311 people, including 1,523 with migraine, 2,366 with tension-type headache and 209 with an unclassified headache. The remaining 1,213 participants reported no headaches during the previous 12 months. The research is published in The Journal of Headache and Pain.
Two in three people with migraine have poor sleep quality
The biggest difference was in sleep quality. Sleep problems were identified in 64.1% of people with migraine, compared with 38.7% of those without headaches. Among people with tension-type headache, the figure was 45.4%.
Sleep quality was assessed using the Pittsburgh Sleep Quality Index, which accounts for factors such as time needed to fall asleep, sleep duration and efficiency, nighttime awakenings and daytime functioning.
People with migraine scored worse than those without headaches across all assessed aspects of sleep. These differences remained significant even after accounting for factors such as age, sex, place of residence, education, relationship status and type of employment.
"The significantly higher proportion of people with sleep problems among patients with migraine compared with the control group confirms that sleep disturbances are one of the key features of this condition. This difference points to a strong bidirectional relationship: On the one hand, poorer sleep quality increases the frequency of migraine attacks and reduces quality of life, while on the other hand, the disease process itself disrupts sleep physiology," says Waliszewska-Prosół of the Department of Neurology at Wroclaw Medical University.
Poorer sleep is associated with a greater migraine burden
The relationship between sleep and migraine extended beyond the presence of the condition itself. Among people with migraine, poorer sleep quality was associated with more frequent attacks, greater disability, higher levels of stress and anxiety, and lower life satisfaction. The strongest correlation was between poorer sleep quality and reduced quality of life.
Migraine and sleep have a bidirectional relationship. Both insufficient and excessive sleep can increase susceptibility to pain, while a migraine attack and its accompanying symptoms can make it difficult to fall asleep and cause nighttime awakenings.
Both phenomena share common neurobiological mechanisms. The hypothalamus and neurotransmitters that regulate circadian rhythms and pain perception play a role in both sleep and migraine.
"The findings highlight that sleep plays a fundamental role in the pathophysiology of migraine, and that assessing sleep and improving sleep hygiene should become a standard part of patient care," emphasizes Waliszewska-Prosół.
Is migraine more common among 'night owls'?
The researchers also examined participants' chronotypes, which describe natural preferences regarding sleep and activity times. People with a morning chronotype, often referred to as "larks," generally fall asleep and wake up earlier and perform best during the first part of the day. Those with an evening chronotype, or "night owls," prefer later hours for both rest and activity.
The migraine group showed a shift toward a later chronotype. Morning types accounted for 24.9% of people with migraine, compared with 39.1% of those without headaches.
This does not mean, however, that being a "night owl" directly causes migraine or that everyone who prefers later hours of activity is at greater risk of developing the condition. Differences between the analyzed groups were small, and correlations between chronotype and the clinical course of migraine were weak. The researchers therefore recommend caution when interpreting the clinical significance of this finding.
"The relationship is more complex, although the study clearly shows that people with migraine demonstrate a significant shift toward a later, evening chronotype, as well as a lower proportion of morning types. This means a tendency to be a night owl, or to have an evening chronotype, coexists with migraine and is associated with circadian rhythm disturbances. However, correlations between the chronotype score itself and clinical indicators were weak," explains Waliszewska-Prosół.
"Nevertheless, this is a unique observation pointing to shared neurobiological mechanisms, including disturbances in hypothalamic function and neurotransmitters that regulate both the biological clock and pain perception," the researcher adds.
Sleep as an important element of migraine care
The study findings indicate that assessing sleep quality should become a routine part of the medical history. Problems reported by patients extend beyond sleep duration and include difficulty falling asleep, frequent nighttime awakenings and impaired daytime functioning.
Because the analysis is cross-sectional, the study cannot establish cause-and-effect relationships. In addition, the authors assessed both sleep parameters and migraine severity using self-reported questionnaires, without objective methods such as polysomnography.
The findings therefore require caution. They do not demonstrate that a late chronotype directly causes migraine, nor that improving sleep hygiene alone will completely prevent migraine attacks. Nevertheless, sleep is a key component of the clinical picture and should be considered in both diagnosis and treatment. Determining the precise direction of these relationships will require further longitudinal studies using objective measurement tools.
More information
Karol Marschollek et al, Sleep quality and chronotype in primary headache disorders: a nationwide population-based study of 5,311 Polish adults, The Journal of Headache and Pain (2026). DOI: 10.1186/s10194-026-02425-9
Key medical concepts
MigrainePoor sleepPittsburgh Sleep Quality Index
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