Characterizing insomnia and sleep quality in a cohort with tension type headache.

Objectives: Emerging literature data indicate insomnia as an risk factor for headache or migraine onset. It is generally recognized that headache and insomnia represent very common and major complaints worldwide, while finding exisit that indicate a symmetrical association, with headache being more associated with insomnia than the other way around. Therefore, in the association of headache and insomnia, other factors associated with headache or migraine probably play a role, as well. The aim of the study was to evaluate the clinical and pathogenetic relationships between insomnia and chronic tension-type headache (CTTH). Methods: A prospective cohort study included 65 patients with CTTH and comorbid chronic insomnia. Participants underwent clinical evaluation, assessment of headache severity (VAS, HIT-6), insomnia (PSQI, ISI), emotional state (Beck, Sheehan scales), and quality of life (SF-12). A subset (n=17) underwent polysomnography (PSG). Results: All patients reported poor sleep quality. A significant discrepancy was found between subjective sleep perception and objective PSG data (p<0.001). Patients with more severe insomnia had significantly higher levels of anxiety (p<0.001), depression (p=0.025), central sensitization (p<0.001), and lower quality of life (p<0.002). Correlation analysis revealed that worse sleep parameters (e.g., reduced REM, increased wakefulness) were associated with higher headache impact, emotional distress, and central sensitization, particularly in the mild insomnia group. Conclusions: Insomnia in CTTH patients exacerbates the condition not primarily by intensifying pain itself, but by amplifying its negative impact on emotional state and quality of life, and by strengthening the interconnections between various clinical and psychophysiological manifestations. Treating insomnia is crucial for improving overall patient well-being and pain tolerance.