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Poor subjective sleep quality is common in tension-type headache and associated with depressive symptoms

The pooled prevalence of poor sleep quality (PSQI >5) in adults with tension-type headache was 67% (95% CI 53-79%). The mean PSQI score was 9.48, significantly higher than controls (mean difference 3.77, 95% CI 2.32-5.22), and correlated robustly with depression (r=0.51).

Last updated: Jul 28, 2026•0 RCTs•1 Meta-analyses•📖 Read as article →

Evidence Score

Evidence Score49/100
Human RCT☆☆☆☆☆
Meta-analysis★★★☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Sleep disturbances in tension-type headache: a systematic review and meta-analysis.

meta

Yuan L, Kulachai P, Wu QM, Zhang YX, Niu XY, Liang JT, Zheng H · Journal of neurology (2026)

Participants: 27
Duration: N/A
Intervention: None (observational study of sleep outcomes in TTH)
Outcome: Prevalence of poor sleep quality (PSQI >5), mean PSQI score, sleep duration, insomnia, excessive daytime sleepiness, OSA risk
Effect Size: Pooled prevalence 67% (95% CI 53-79%); mean difference in PSQI vs controls = 3.77 (95% CI 2.32-5.22); correlation with depression r=0.51
Population: Adults with tension-type headache (TTH) from 27 observational studies

Result: The pooled prevalence of poor sleep quality (PSQI >5) in adults with tension-type headache was 67% (95% CI 53-79%). The mean PSQI score was 9.48, significantly higher than controls (mean difference 3.77, 95% CI 2.32-5.22), and correlated robustly with depression (r=0.51).

PubMed: 42493638DOI: 10.1007/s00415-026-14011-9

Mechanism Graph

Tension-type headache is associated with central sensitization and pain processing abnormalities
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Sleep disturbances may exacerbate pain sensitivity and headache frequency
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Depressive symptoms are strongly correlated with poor sleep quality in TTH patients
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Result: Bidirectional relationship between sleep disturbance and TTH, with depression as a key mediator

Limitations

  • ⚠High heterogeneity (I²=97%) across studies, partly explained by recruitment settings
  • ⚠Correlations with headache frequency and intensity were nominal and exploratory, not robust after multiple testing correction

Frequently Asked Questions

What percentage of people with tension-type headache have poor sleep quality?▼

The pooled prevalence is 67% based on PSQI scores, though estimates ranged from 53% to 79% across studies.

Is poor sleep quality in tension-type headache linked to depression?▼

Yes, the correlation between PSQI scores and depressive symptoms was strong (r=0.51) and statistically significant after correction for multiple testing.

Does sleep duration differ between TTH patients and controls?▼

No, mean sleep duration was 6.61 hours and did not differ significantly from non-headache controls.

What sleep disorders are common in tension-type headache?▼

Insomnia was reported in 37%, excessive daytime sleepiness in 13%, and high OSA risk or confirmed OSA in 26% of TTH patients.

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References

  1. 1.Yuan L, Kulachai P, Wu QM, Zhang YX, Niu XY, Liang JT, Zheng H. "Sleep disturbances in tension-type headache: a systematic review and meta-analysis.." Journal of neurology, 2026. PMID: 42493638 DOI: 10.1007/s00415-026-14011-9
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