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Curr Neurol Neurosci Rep (2015) 15:520
DOI 10.1007/s11910-014-0520-2
SLEEP (M THORPY, M BILLIARD, SECTION EDITORS)
Tension-Type Headache and Sleep
Jeanetta C. Rains & Rachel E. Davis & Todd A. Smitherman
Published online: 5 December 2014# Springer Science+Business Media New York 2014
Abstract This review describes empirical evidence for a bidirectional relationship between tension-type headache (TTH) and sleep. In its most severe form, chronic TTH (CTTH) affects 23 % of the population and can be very disabling. Sleep dysregulation triggers episodic TTH, and sleep disorders may complicate and exacerbate headache. The majority of CTTH sufferers also have insomnia, and longitudinal data suggest that insomnia is a risk factor for new-onset TTH. Similarly, observational studies suggest that sleep disturbance is a risk factor for new-onset TTH and for progression from episodic to chronic TTH (i.e., headache chronification). CTTH is the most common headache secondary to sleep apnea and other sleep-related breathing disorders. Psychiatric disorders are comorbid with both TTH and insomnia and may further complicate diagnosis and treatment. Developments in diagnostic classification of sleep-related headache are presented.
Keywords Tension-type headache . Headache . Awakening headache .Morningheadache .Sleep-relatedheadache .Sleep apnea headache . Snoring . Insomnia . Psychiatric comorbidity . Chronification
Introduction
Tension-type headache (TTH) is the most common headache and, indeed, pain condition worldwide, but TTH historically has been a relatively neglected subject of research. TTH ranges from infrequent, mild variants to a chronic, severe, and disabling condition. TTH has received much less attention than its migraine counterpart, although the two often co-occur, especially in more severe and complicated headache presentations. Likely, the relative neglect of TTH stems from the historical view of TTH as psychogenic and perhaps also from the fact that milder forms are almost ubiquitous and relatively innocuous. Though less is known about the pathophysiology of TTH compared to migraine, the past decade has yielded important diagnostic, epidemiological, observational, clinical, and experimental evidence advancing our understanding of TTH and interrelated sleep disorders and processes.
The association between sleep and headache has been recognized in the medical literature for over a century and has been described extensively in earlier literature reviews [1, 2, 3, 4]. Earlier studies often lacked diagnostic precision, frequently reporting on headaches proximally related to sleep (e.g., morning headache, awakening headache) rather...