Screening for Insomnia: An Observational Study Examining Sleep Disturbances, Headache Characteristics, and Psychiatric Symptoms in Patients Visiting a Headache Center

Effective treatments for insomnia exist, but few physicians treating headaches have routine methods for screening for insomnia. We sought to 1) describe the migraine characteristics and comorbid conditions that can affect sleep and 2) assess their relationships with positive screens on the Insomnia Severity Index (ISI).

This is a retrospective cross-sectional study of the migraine and sleep characteristics of new patients in our headache center (August 15, 2015-October 28, 2015) who were suspected of having migraines based on the new patient intake questionnaire. The questionnaire included the ISI, questions about headache characteristics, and screens for psychiatric comorbidities. Two tailed t tests and analysis of variance evaluated relationships between headache characteristics, comorbidities, and ISI score.

A total of 61 new patients were suspected to have migraines. The mean number of headache days per month was 11.6. Only 41% of patients reported sleeping seven or more hours; 49.2% had an ISI of 15 or higher (positive screen). Regarding the insomnia scores, there were no differences between moderate and severe headache pain, between episodic and chronic headaches, and between the associated symptoms (nausea/vomiting, photophobia, phonophobia; P > 0.05). Musculoskeletal pain (18.7 vs 13.8, P = 0.027), depression (rho = 0.610), and general anxiety (rho = 0.436) were associated with higher ISI scores.

Nearly half of the patients with suspected migraines in a headache center screened positive for insomnia, independent of whether they had episodic or chronic headaches. This would generate a substantial number of cognitive behavioral therapy for insomnia (CBT-I) referrals. Given the strong association between comorbid musculoskeletal pain, depression, anxiety, and insomnia, we suggest prioritizing CBT-I referral for those patients regardless of their headache frequency.