title: Pain coping strategies for tension-type headache: possible implications for insomnia?
abstract: OBJECTIVE
  Insomnia has been identified as a risk factor for tension-type headache, although the pathogenesis of sleep disturbance in this population is unclear. The present study examined pain-related self-management strategies in a nonclinical, young-adult sample for preliminary evidence to support a novel hypothesis for the development of insomnia in this population.
  
  
  METHODS
  Self-report data on triggers of headache, pain interference with sleep, and pain-related self-management strategies were analyzed for 32 women with tension-type headache and 33 women with minimal pain who served as controls.
  
  
  RESULTS
  The results revealed that a significantly greater proportion of the headache group relative to the control group reported sleep problems as a trigger of headaches, stress as a trigger of headache, and going to sleep as a coping strategy for pain. The headache group also reported significantly higher ratings of pain interference with sleep. Going to sleep was the most commonly used self-management strategy (81%) by headache sufferers and also rated as the most effective strategy (5.5 out of 7.0).
  
  
  CONCLUSIONS
  These findings suggest that a bidirectional relationship between sleep disturbance and headache is present in this young-adult sample. Furthermore, the frequent use of sleep as a self-management strategy for pain is consistent with the hypothesis that sleep-seeking behavior might be a mediating factor in the development of insomnia among people with tension-type headache. This hypothesis fits within the most widely accepted conceptual model of chronic insomnia and should be further investigated in individuals with both tension-type headache and insomnia.
authors.affiliation: Sleep Disorders Service and Research Center, Department of Behavioral Sciences, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612-3833, USA. Jason_Ong@rush.edu
authors.forename: Jason C
authors.initials: JC
authors.lastname: Ong
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Stepanski
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Gramling