Low Sleep Efficiency Associated With Higher Odds of Migraine, Study Shows

Sleep fragmentation, which is defined by low sleep efficiency, was linked with higher odds of migraine onset on day 1, according to study findings published this week.

Sleep fragmentation, which is defined by low sleep efficiency, was linked with higher odds of migraine onset on day 1, according to study findings published this week in the journal Neurology.

In nearly half of all patients with migraine, sleep disturbance is reported as a trigger for symptom recurrence. However, the attributable cause of this association has not been delineated through prior studies. Lead study author Suzanne Bertisch, MD, MPH, physician and clinical investigator in the Division of Sleep and Circadian Disorders at the Brigham and Women’s Hospital, noted that many patients with migraine who also suffer from insomnia are referred to her in the sleep clinic, but the lack of data on the relationship makes it difficult to choose which treatments would work best.

“Anyone treating these patients wants to be able to counsel them on what to do to decrease their risk of a migraine, but the literature is unclear on what kind of sleep interventions may be helpful," said Bertisch.

Researchers sought to evaluate the temporal relationship between sleep and migraine onset through focusing on hypotheses such as insufficient duration, high fragmentation, and poor sleep quality. Assessments were conducted in the largest prospective study to date to examine objective measures of sleep:

  • Prospective cohort included 98 adults (mean age = 35.1 ± 12.1 years) with episodic migraine
  • Participants wore wrist actigraphs for 6 weeks and completed twice-daily electronic diaries on sleep, headaches, and other health habits
  • Researchers estimated incidence of migraine following nights with short sleep duration, high fragmentation, or low quality and compared data to nights with adequate sleep
  • Analyses conducted with conditional logistic regression models stratified by participant and adjusted for caffeine intake, alcohol intake, physical activity, stress, and day of week

Results were derived from 4406 days of data, with 870 headaches reported among the study cohort. In the analysis, sleep duration (≤6.5) and poor sleep quality were not found to be associated with onset migraine on day 0 or day 1.

Conversely, sleep fragmentation exhibited a definite relationship with migraine onset as diary-reported low efficiency was linked with 39% higher odds of headache on day 1 (odds ratio [OR] = 1.39; 95% CI, 1.06—1.81) and actigraphic-assessed high fragmentation was associated with lower odds of migraine on day 0 (wake after sleep onset >53 minutes; OR = 0.64, 95% CI, 0.48-0.86; efficiency ≤ 88%, OR = 0.74, 95% CI, 0.56–0.99).

"Sleep is multi-dimensional, and when we look at certain aspects such as sleep, we found that low sleep efficiency, which is the amount of time you're awake in bed when you're trying to sleep, was associated with migraines not on the day immediately following, but on the day after that," said Bertisch. Although short sleep duration and low sleep quality were not found to be temporally associated with migraine, the study authors noted that the link found between sleep fragmentation and risk of migraine warrants further research to understand the clinical and neurobiologic implications.


Bertisch SM, Li W, Buettner C, et al. Nightly sleep duration, fragmentation, and quality and daily risk of migraine. [published online December 16, 2019]. Neurology. doi: 10.1212/WNL.0000000000008740.