Daily Perceived Stress and Sleep Duration in Chronic and Episodic Migraine

Abstract

Objective: Migraine is a prevalent neurologic disorder, and can be episodic (EM), < IS headache days / month, or chronic (CM), ≥ 15 headache days / month. Perceived stress and poor sleep duration are plausible migraine precipitating factors. Understanding differences in perceived stress and sleep in EM and CM will provide clinically useful information regarding potential targets for behavioral interventions, and provide insight into possible risk factors for chronification of EM to CM.

Method: Participants were 46 adults with EM or CM, recruited from the general population. Perceived stress was evaluated using the Perceived Stress Scale (PSS-4), where clinically important high stress was determined by sample IQRs at PSS-4 scores > 7. Sleep was evaluated with the question "E-low many hours did you sleep last night?", where clinically important short sleep was determined using the National Sleep Foundation's guidelines as < 7 hours per night. Multiple repeated measures mixed models, logistic and linear regressions were utilized for main analysis.

Results: The majority of the study sample was highly educated, white/non-Hispanic females, mean age of 40. Half had EM (N = 22) and half had CM (N = 24). CM was associated with higher levels off clinically high perceived stress and clinically short sleep than EM [Estimate = 1.61, SE = 0.64, 95% CI = (0.36, 2.85); Estimate = 1.14, SD = 0.58, 95% CI = (0.00, 2.28)]. Higher migraine and headache days were also associated with higher perceived stress [Estimate = 1.1 1, SE = .14, 9.5% CI = (0.84, 1.38); Estimate = 1.13, SE = .12, 95% CI = (0.89, 1.36)].] and lower hours of sleep [Estimate = - 0.18, SE = 0.09, 95% CI = (-0.37, -0.01); Estimate = -0.22, SE = 0.08, 95% CI = (-0.37, -0.06)].

Conclusions: High perceived stress and short sleep were higher in those with CM vs EM and should be closely considered as a precipitating factor when seeing a patient with migraine. Future studies should explorc roles that perceived stress and sleep may play in chronification, as well as potentially different treatment effects on modifiable behavioral targets in EM vs CM.