Pediatric Headache and Sleep Disturbance: A Comparison of Diagnostic Groups
Jonathan Rabner1, Karen J Kaczynski1,2, Laura E Simons3
1Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
Insights
Pediatric patients with tension-type headache (TTH) and new daily persistent headache (NDPH) experience greater sleep disturbance than those with migraine. Sleep issues are linked to disability, anxiety, and depression in children with chronic headaches.
Area of Science:
- Pediatric neurology
- Sleep medicine
- Child psychology
Background:
- Primary headache disorders significantly impact children's quality of life.
- Chronic headaches and sleep difficulties in youth often have a bidirectional relationship.
- Limited research exists on sleep disturbances in pediatric tension-type headache (TTH) and new daily persistent headache (NDPH) compared to migraines.
Purpose of the Study:
- To investigate sleep disturbance variations across different pediatric primary headache diagnoses.
- To determine if headache diagnosis predicts sleep disturbance after accounting for other factors.
Main Methods:
- Retrospective chart review of 527 pediatric patients (ages 7-17) with migraine, TTH, or NDPH.
- Parental assessment of sleep disturbance.
- Patient assessment of disability, anxiety, and depression.
Main Results:
- Patients with TTH and NDPH reported significantly greater sleep disturbance than those with migraine.
- Sleep disturbance correlated with higher functional disability, anxiety, and depression across all groups.
- Older age, higher disability, depression, and NDPH diagnosis were significant predictors of sleep disturbance.
Conclusions:
- Sleep disturbance is a critical issue in pediatric chronic headache patients.
- Headache diagnosis and factors like disability and emotional distress influence sleep severity.
- Comprehensive assessment and treatment of sleep problems are essential for this population.
Objective:
To examine whether sleep disturbance differs by headache diagnosis in a pediatric sample, and whether this effect remains when other factors affecting sleep are included.
Background:
Primary headache disorders can be severe and disabling, impacting a child's functioning and quality of life. Many children and adolescents with chronic headaches also experience sleep difficulties, and there is likely a bidirectional relationship between headaches and sleep difficulties. Sleep problems may intensify functional and developmental difficulties in youth with chronic headaches. Despite this, research on sleep has largely been conducted only on those with migraines, with a dearth of studies including samples with tension-type headache (TTH) or new daily persistent-headache (NDPH).
Methods:
This retrospective chart review included 527 patients, ages 7-17 years, with a primary headache diagnosis of migraine (n = 278), TTH (n = 157), and NDPH (n = 92). Patients completed measures of disability, anxiety, and depression and their parents completed measures of sleep disturbance.
Results:
Sleep disturbance was greater in patients with TTH (10.34 ± 5.94, P = .002) and NDPH (11.52 ± 6.40, P < .001) than migraine (8.31 ± 5.89). Across patient groups, greater sleep disturbance was significantly associated with higher levels of functional disability (rs ≥ .16), anxiety (rs ≥ .30), and depression (rs ≥ .32). Additionally, higher pain levels were significantly associated with greater sleep disturbance among TTH patients (r = .23), with this association non-significant among the other headache groups. When simultaneously examining demographic, pain-related, and emotional distress factors, older age, higher levels of disability and depression, and NDPH diagnosis were all significant predictors of greater sleep disturbance (r2 = .25).
Conclusions:
Assessment and treatment of sleep problems in pediatric patients with chronic headache is important with several contextual and headache diagnostic factors influencing the severity of sleep disturbance.
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