Sleep quality and chronotype in primary headache disorders: a nationwide population-based study of 5,311 Polish adults

Jun 19, 2026The journal of headache and pain

Sleep quality and natural sleep-wake patterns in common headache disorders: a study of 5,311 adults in Poland

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Abstract

Participants with migraine reported the poorest sleep quality, with a median Pittsburgh Sleep Quality Index score of 7 compared to 5 in controls.

Migraine sufferers had a prevalence of poor sleep quality at 64.1%, significantly higher than the 38.7% in headache-free individuals.
Higher Pittsburgh Sleep Quality Index scores were significantly associated with migraine (β = 2.09), unclassified headache (β = 1.57), and tension-type headache (β = 0.59).
Migraine patients exhibited a significant shift toward an evening chronotype (adjusted β = -1.38) and lower representation of morning types (24.9% vs. 39.1% in controls).
In the migraine subgroup, poorer sleep quality was moderately correlated with lower quality of life (r = -0.45) and higher perceived stress (r = 0.34).
Chronotype scores showed only weak correlations with clinical outcomes in migraine patients.

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BACKGROUND: Primary headache disorders, particularly migraine, are closely linked to sleep disturbances. However, the relationship between headache phenotypes, sleep quality, and chronotype in large populations remains to be fully elucidated. This study aimed to investigate sleep quality and chronotype across different primary headache types compared to headache-free individuals.

METHODS: This nationwide, cross-sectional study included 5,311 Polish adults recruited via an online research panel. Headaches were classified using the HARDSHIP questionnaire according to ICHD-3 criteria. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and chronotype using the Morningness-Eveningness Questionnaire (MEQ). Sleep-related variables were then compared between specific headache types and individuals without headache.

RESULTS: Participants with migraine (n = 1,523) reported the poorest sleep quality (median PSQI: 7 vs. 5 in controls) and the highest prevalence of poor sleep (64.1% vs. 38.7% in controls; p < 0.001). After adjustment, migraine (β = 2.09), unclassified headache (β = 1.57), and tension-type headache (TTH; β = 0.59) remained significantly associated with higher PSQI scores. Regarding chronotype, the migraine group showed a significant shift toward eveningness (adjusted β=-1.38; p < 0.001) and a lower representation of morning types (24.9% vs. 39.1% in controls). In the migraine subgroup, poorer sleep quality was moderately correlated with lower quality of life (r=-0.45) and higher perceived stress (r = 0.34), whereas MEQ scores showed only weak correlations with clinical outcomes.

CONCLUSIONS: Poor sleep quality and an evening chronotype are prominent features of primary headache disorders, especially migraine. Future prospective studies are needed to determine the causality of these associations. Meanwhile, sleep quality assessment and interventions aiming to improve sleep patterns should be considered in migraine patients.

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Sleep quality and chronotype in primary headache disorders: a nationwide population-based study of 5,311 Polish adults

Abstract

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