Morning headache in habitual snorers: Frequency, characteristics, predictors and impacts

• Published in: Cephalalgia Vol. 31; no. 7; pp. 829 - 836
• Main Authors: Chen, Ping-Kun, Fuh, Jong-Ling, Lane, Hsien-Yuan, Chiu, Pai-Yi, Tien, Hui-Chi, Wang, Shuu-Jiun
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.05.2011
• Subjects: Adolescent; Adult; Aged; Female; Headache - complications; Headache - epidemiology; Humans; Male; Middle Aged; Migraine Disorders - complications; Migraine Disorders - epidemiology; Odds Ratio; Polysomnography; Quality of Life; Risk Factors; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - epidemiology; Sleep Initiation and Maintenance Disorders - complications; Sleep Initiation and Maintenance Disorders - epidemiology; Snoring - complications; Snoring - epidemiology; Stress, Psychological - complications; Stress, Psychological - epidemiology; Young Adult; sleep apnoea headache; migraine; morning headache; quality of life; Insomnia; snoring
• ISSN: 0333-1024; 1468-2982
• DOI: 10.1177/0333102411403635

Objectives: Morning headache has been considered as an accompanying symptom of obstructive sleep apnoea syndrome (OSAS). However the frequency, characteristics, predictors and impacts of morning headache in habitual snorers are not well defined. Methods: We studied consecutive patients with habitual snoring in a sleep laboratory using polysomnography. All patients were interviewed by a physician regarding the presence or absence of morning headache, migraine and insomnia. Each patient completed the Short Form-36 health survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Morning headache was defined as headache on awakening ≥1 day/week for ≥6 months. Results: Of the 268 participants with habitual snoring, 63 (23.5%) had morning headache and 184 (69%) had OSAS. Patients with morning headache reported lower scores in all eight domains of the SF-36 than those without (difference: 10.6 to 29.7 points, all p ≤ 0.005). The independent predictors of morning headache were migraine (adjusted odds ratio (AOR) 6.3), insomnia (AOR 4.2), psychological distress (HADS ≥ 8) (AOR 3.9) and OSAS (AOR 2.6). Morning headache in 12 patients (19%) fulfilled the criteria for migraine attacks. Conclusions: Morning headache was common in habitual snorers and associated with a pervasive impairment of health-related quality of life. Migrainous features were not uncommon. Not only OSAS, but migraine, insomnia and psychological distress were also important predictors for morning headache, even in snoring patients.