title: Does menopause influence nocturnal awakening with headache?
abstract: OBJECTIVE
  The aim of the present study was to assess whether menopausal status influences the occurrence of nocturnal awakening with headache (NAH) in the female population of Sao Paulo, Brazil. We also examined the relationship of this complaint to sociodemographic determinants, hot flushes, sleep quality and parameters, anxiety and depressive symptoms, somnolence and fatigue according to menopausal status.
  
  
  METHODS
  The female population of the Sao Paulo Epidemiologic Sleep Study (EPISONO) (n = 576) was divided according to menopausal status (pre-, peri-, early and late menopause) based on questionnaires and hormonal blood measures. The complaint of waking up because of a headache at least once a week was assessed by the UNIFESP Sleep questionnaire. Additionally, hot flushes, sleep complaints, anxiety and depressive symptoms, somnolence and fatigue were assessed by specific questionnaires. A full-night polysomnography assessed sleep parameters.
  
  
  RESULTS
  The prevalence of NAH in women in the Sao Paulo population was 13.3%. Perimenopause was associated with a higher risk of having NAH (odds ratio 13.9; 95% confidence interval 4.3-45.2). More complaints of NAH were observed in obese women. All the groups with NAH showed more hot flushes, worse subjective sleep quality, more complaints of insomnia, anxiety symptoms and fatigue.
  
  
  CONCLUSIONS
  We observed a constellation of symptoms in women according to menopausal status and NAH that included hot flushes, sleep complaints, more anxiety symptoms and fatigue. Moreover, some of these symptoms were more frequent in perimenopausal women with NAH. Therefore, we concluded that menopausal status influences NAH and the women in perimenopause presented a high risk of having this complaint.
authors.affiliation: Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo/SP, Brazil.
authors.forename: L M
authors.initials: LM
authors.lastname: Lucchesi
authors.forename: H
authors.initials: H
authors.lastname: Hachul
authors.forename: F
authors.initials: F
authors.lastname: Yagihara
authors.forename: R
authors.initials: R
authors.lastname: Santos-Silva
authors.forename: S
authors.initials: S
authors.lastname: Tufik
authors.forename: L
authors.initials: L
authors.lastname: Bittencourt
mesh_terms: D001007:Anxiety / Q000453:epidemiology; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006261:Headache / Q000453:epidemiology*; D019584:Hot Flashes / Q000453:epidemiology; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000503:physiopathology*; D011795:Surveys and Questionnaires