Abstract
ObjectiveTo investigate variables associated at baseline (cross-sectional design) and at one year (longitudinal design) with the quality of sleep in chronic tension-type headache (CTTH).MethodsOne hundred and eighty (n = 180) and 135 individuals with CTTH participated in the cross-sectional and longitudinal design respectively. Clinical features were collected with a 4-weeks headache diary at baseline and one-year follow-up. Sleep quality was assessed at baseline and 1-year follow-up with the Pittsburgh Sleep Quality Index. Anxiety and depression (Hospital Anxiety and Depression Scale-HADS), burden of headache (Headache Disability Inventory-HDI), quality of life (SF-36 questionnaire), and pressure pain thresholds (PPTs) at trigeminal, extra-trigeminal and widespread area were assessed at baseline. Hierarchical regression analyses were conducted to determine the associations between variables at baseline and 1-year follow-up with sleep quality.ResultsAt baseline positive correlations between sleep quality and headache intensity, headache frequency, headache duration, emotional and physical burden of headache and depression were observed. The regression analyses found that depression and emotional burden of headache explained 27.5% of the variance in sleep quality at baseline (r2 = .262; F = 23.72 P < .001). At one-year, sleep quality was significantly associated with baseline burden of headache, depression, widespread PPTs, vitality and mental health domains. Regression analyses revealed that vitality, PPT over the second metacarpal and PPT over the neck explained 30.0% of the variance of sleep quality at one-year (r2 = .269, F = 9.71, P < .001).ConclusionsIt seems that sleep quality exhibits a complex interaction in individuals with CTTH since depression and the emotional burden were associated with sleep quality at baseline, but vitality and PPTs over extra-trigeminal areas were associated with the quality of sleep at one-year.
Highlights
Tension-type headache (TTH) is a frequent pain disorder with a global prevalence of 42% in the general population [1] and showing an important socio-economic impact [2]
At one-year, sleep quality was significantly associated with baseline burden of headache, depression, widespread pressure pain thresholds (PPTs), vitality and mental health domains
Variables associated with sleep in tension type headache analyses revealed that vitality, PPT over the second metacarpal and PPT over the neck explained 30.0% of the variance of sleep quality at one-year (r2 = .269, F = 9.71, P < .001)
Summary
Tension-type headache (TTH) is a frequent pain disorder with a global prevalence of 42% in the general population [1] and showing an important socio-economic impact [2]. The presence of central sensitization is generally attributed to long-lasting prolonged bombardment of nociceptive afferences or stimulus arriving to the central nervous system and to the trigemino-cervical nucleus caudalis This process is important in CCTH patients, since a higher frequency of headache attacks is able of triggering hyperalgesic responses in the central nervous system and promoting pain [5]. It is important to consider that headache attacks, and several physical, physiological or emotional factors may influence the excitability of the central nervous system observed in subjects with CTTH and could contribute to the development and/or maintenance of the symptoms Among these potential factors, depression, anxiety, or sleep disorders play a relevant role in the process of sensitization of central nervous pathways since they are able of triggering hyperalgesic responses by increasing pressure pain hypersensitivity [6]. Current research suggests that one of the main manifestations of sensitization mechanisms in patients with CTTH is the presence of widespread pressure pain hyperalgesia, which is not present in those with the episodic form [5]
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