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Headache. 2005 Jun;45(6):657-69.

Psychological, sleep, lifestyle, and comorbid associations with headache.

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Primary Care Sciences Research Centre, Keele University, Keele, Staffordshire, UK.



To investigate the associations of headache occurrence, severity, and frequency with psychological, sleep, and lifestyle characteristics, and comorbid conditions.


Whilst associations for individual headache types, particularly migraine, have been investigated, possible associations between headache of all types and general health characteristics have not been explored.


Cross-sectional postal survey in an adult general population sample registered at five general practices in North Staffordshire, UK.


Headache occurrence was associated with anxiety (odds ratio 4.09, 95% confidence interval 3.0, 5.6) and sleep problems (moderate sleep problems OR 3.60, 95% CI 2.5, 5.0), and the strength of the associations increased with higher levels of anxiety and sleep problem. Whilst depression showed an association with headache, this was not seen in respondents with depression in the absence of anxiety. Headache occurrence was also associated with comorbid pain anywhere in the body (OR 2.12, 95% CI 1.7, 2.6), with the strongest associations being for the neck and upper body areas compared with other areas. There was no overall link with alcohol or caffeine consumption. Increasing severity and frequency of headache resulted in stronger associations, and there were strong associations between the occurrence, severity, and frequency of headache, and both sleep problems and psychological distress.


Poor sleep and anxiety appear to make a substantial contribution to the impact of headache on sufferers' lives in the general population.

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