title: Sleep quality, arousal and pain thresholds in tension-type headache: a blinded controlled polysomnographic study.
abstract: BACKGROUND
  We aimed to compare subjective and objective sleep quality in tension-type headache (TTH) patients and to evaluate the relationship between sleep quality and pain thresholds (PT) in controls and TTH patients.
  
  
  METHODS
  A blinded cross-sectional study where polysomnography (PSG) and PT (to pressure, heat and cold) measurements were done in 20 patients with TTH (eight episodic (ETTH) and twelve chronic (CTTH) TTH) and 29 healthy controls. Sleep diaries and questionnaires were applied.
  
  
  RESULTS
  TTH patients had more anxiety ( P = 0.001), insomnia ( P < 0.0005), daytime tiredness ( P < 0.0005) and reduced subjective sleep quality ( P < 0.0005) compared to healthy controls. Sleep diaries revealed more long awakenings in TTH ( P = 0.01) but no total sleep-time differences. TTH patients had more slow-wave sleep ( P = 0.002) and less fast arousals ( P = 0.004) in their PSGs. CTTH subjects had lower pressure PT ( P = 0.048) and more daytime sleepiness than the controls ( P = 0.039). Among TTH lower cold PT (CPT) correlated inversely with light sleep (N1) ( R  = -0.49, P = 0.003) while slow arousals correlated inversely with headache-frequency ( R  = -0.64, P = 0.003).
  
  
  CONCLUSIONS
  We hypothesize that TTH patients need more sleep than healthy controls and might be relatively sleep deprived. Inadequate sleep may also contribute to increased pain sensitivity and headache frequency in TTH.
authors.affiliation: Department of Neuroscience; Norwegian University of Science and Technology, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Engstrøm
authors.forename: K
authors.initials: K
authors.lastname: Hagen
authors.forename: M
authors.initials: M
authors.lastname: Bjørk
authors.forename: L J
authors.initials: LJ
authors.lastname: Stovner
authors.forename: M
authors.initials: M
authors.lastname: Stjern
authors.forename: T
authors.initials: T
authors.lastname: Sand
mesh_terms: D000328:Adult; D001143:Arousal; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017288:Pain Threshold; D017286:Polysomnography; D012890:Sleep; D011795:Surveys and Questionnaires; D018781:Tension-Type Headache / Q000150:complications*
keywords: Tension-type headache; arousals; pain thresholds; polysomnography; sleep