Sleep disturbances in tension-type headache: a systematic review and meta-analysis

Area of Science:

• Neurology
• Sleep Medicine
• Clinical Research

Background:

• Tension-type headache (TTH) is the most prevalent primary headache disorder globally.
• Sleep disturbances are frequently reported in TTH patients but lack quantitative synthesis.
• Understanding the relationship between TTH and sleep is crucial for comprehensive patient care.

Purpose of the Study:

• To quantitatively synthesize the prevalence of sleep disturbances in adults with TTH.
• To assess the association between TTH and poor sleep quality compared to non-headache controls.
• To explore correlations between sleep quality and other factors like depression and headache burden.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, Embase, Web of Science, Cochrane Library) up to January 2026.
• Observational studies reporting sleep outcomes in adults with TTH were included.
• Meta-analysis using random-effects models was employed to pool prevalence and mean scores; study quality was assessed using Joanna Briggs Institute checklists.

Main Results:

• Twenty-seven studies revealed a pooled prevalence of poor sleep quality in 67% of TTH patients (95% CI 53-79%).
• The mean Pittsburgh Sleep Quality Index (PSQI) score was significantly higher in TTH patients (9.48) compared to controls (MD=3.77, p<0.01).
• Insomnia, excessive daytime sleepiness, and OSA risk were reported in 37%, 13%, and 26% of TTH patients, respectively; PSQI scores strongly correlated with depression (r=0.51).

Conclusions:

• Poor subjective sleep quality is a common comorbidity in tension-type headache, especially in clinical populations.
• Sleep disturbances in TTH are associated with depressive symptoms and potentially headache burden.
• Routine sleep assessment should be considered in the clinical evaluation of patients with TTH.