The association between sleep duration and migraine frequency, disability, and perceived stress in the Headache Assessment via a Digital Platform in United States (HeAD-US) study

Headache. 2026 Sep 28. doi: 10.1111/head.70215. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the association between self-reported sleep duration and migraine frequency and disability.

BACKGROUND: Adults with migraine have similar average nightly sleep duration compared to those without migraine, but the clinical impact of short or long sleep duration on migraine burden is less well defined.

METHODS: We conducted a cross-sectional analysis from the Headache Assessment via a Digital Platform in the United States (HeAD-US) Study, a survey of adult users of the Migraine Buddy App completed between September and November 2023. Participants reported average nightly sleep duration and headache features, and completed the Perceived Stress Scale-4, the Migraine Disability Assessment Test, and the Patient Health Questionnaire-4 for anxiety and depression. Sleep duration was categorized as short (≤6 h), normal (7-9 h), and long (≥10 h). Migraine diagnosis adhered to the International Classification of Headache Disorders-3.

RESULTS: The 6267 participants had a mean age of 41.5 ± 13.1 years, were 91.7% female, and had a mean sleep duration of 6.92 h (SD 1.32, range 2-15). Compared to normal sleep duration, short sleep was associated with 10.9% higher expected number monthly headache days (adjusted incidence risk ratio [aIRR] = 1.11, 95% confidence interval [CI]: 1.05-1.17) and 13.6% higher expected MIDAS scores (aIRR = 1.14, 95% CI: 1.08-1.20). Long sleep was associated with 27.1% higher expected number of monthly headache days (aIRR = 1.27, 95% CI: 1.07-1.51) and 66.0% higher expected MIDAS scores (aIRR = 1.66, 95% CI: 1.41-1.96). Perceived stress statistically accounted for approximately 48% of the observed association between short sleep duration and monthly headache days (MHD) and 30% of the observed association between long sleep duration and MHD.

CONCLUSIONS: Unhealthy sleep duration, particularly long sleep, is associated with greater migraine burden, characterized by increased headache frequency and disability. Perceived stress statistically accounted for part, but not all, of the observed associations between nonoptimal sleep duration and migraine burden.

PMID:42806598 | DOI:10.1111/head.70215