![]() Patients with migraine fulfilling the criterion for chronic daily headache (more than 15 headache days per month over a 3-month period) but not chronic migraine were diagnosed with episodic migraine. This study extracted data from our headache registry on patients with episodic migraine with or without aura, chronic migraine, and probable migraine (ICHD-3 beta categories 1.1, 1.2, 1.3, and 1.5, respectively) and those with infrequent TTH, frequent TTH, and chronic TTH (ICHD-3 beta categories 2.1, 2.2, and 2.3, respectively). After enrollment in the registry, the patients completed a structured questionnaire specifically designed for each headache disorder depending on their specific diagnosis. If patients gave informed consent, collected data were deposited in our headache registry. After the interview, the study coordinator met the patients and asked if they agreed to being enrolled in the registry. To maintain diagnostic consistency, all of the patients were seen by a single investigator (M.J.L.) again to classify their headache disorders based on the ICHD-3-beta. ![]() and C.S.C.) to evaluate the diagnosis of the headache disorder. They were then interviewed by headache specialists (M.J.L. We also established path models that included the sleep quality, headache frequency, and headache severity to investigate the direct and indirect effects of sleep quality on the headache-related impact.Īll patients who visited our headache clinic were first asked to complete a self-reported, structured headache questionnaire about headache characteristics and patient demographics. We investigated the direct and indirect effects of sleep quality on the headache-related impact by analyzing data from a large number of patients visiting our headache clinic. In this study we hypothesized that worse sleep quality is associated with greater headache-related impact, and we aimed to determine whether sleep affects headache-related impact directly or indirectly by increasing the headache frequency and severity in patients with primary headache disorders. However, whether a poor sleep quality affects the headache-related impact directly or indirectly via increases in the headache frequency and severity has not been reported previously. 6, 7, 8, 9, 10, 11 Consequently, a greater headache-related impact is reported among patients with headache disorders and comorbid poor sleep quality. ![]() The prevalence of poor sleep quality is higher in patients with migraine and TTH, 5 and this is associated with a higher headache frequency and severity in both types of patient. 1, 2 Reducing the burden of headache disorders requires a better understanding of the factors affecting the headache-related impact. 1, 2, 3 The burden of these common headache disorders is still problematic in the global population, with migraine ranking 2nd and TTH ranking 28th among the neurologic disorders that cause disability. Migraine and tension-type headache (TTH) are the most-common primary headache disorders, with migraine affecting 14.4% of people worldwide and the prevalence of TTH ranging from 26.1% to 86.0% depending on the study population.
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