Sleep Disorders in Medication-Overuse Headache: Prevalence and Associated Factors

Sleep disorders can exacerbate headache burden, yet their prevalence and reversibility in medication-overuse headache (MOH) remain unexplored. We aimed to evaluate sleep disorders and associated factors in MOH patients compared with controls, and to assess outcomes following headache treatment.

This prospective case-control study was conducted at a specialised headache center. Patients aged ≥ 18 years with MOH (n = 171; mean age 43.3 years; 81.9% female; migraine 64.9%; tension-type headache 35.1%) and age- and sex-matched headache controls without MOH (n = 173; mean age 41.4 years; 74.6% female; migraine 57.8%; tension-type headache 42.2%) underwent semi-structured interviews and standardised assessments including semi-structured interviews, validated questionnaires, headache and sleep calendars and polysomnography when indicated. Follow-up assessments were performed after headache treatment in 87 MOH patients (mean 24.2 months) and 70 controls (mean 26.4 months).

Chronic insomnia was more prevalent in MOH than in controls (60.2% vs. 47.4%; OR 1.7, 95% CI 1.1-2.6, p = 0.03), as was restless legs syndrome (37.4% vs. 22.0%; OR 2.1, 95% CI 1.3-3.4, p = 0.003). Factors associated with chronic insomnia in MOH included nocturnal headache (OR 2.0), nighttime analgesic use (OR 2.5), overweight (OR 2.7), and arterial hypertension (OR 2.6). Following treatment, chronic insomnia decreased to 33.3% and restless legs syndrome to 14.9% (both p < 0.001), paralleling reductions in headache frequency and analgesic use.

This is the first study to demonstrate high sleep disorder prevalence in MOH and its reversibility following headache treatment. Early screening for sleep disorders in MOH patients is recommended.