Nocturnal Awakening with Headache: A Population-based Longitudinal Study of the City of São Paulo, Brazil

Keywords

sleep - nocturnal awakening - headache

Introduction: The complaint of nocturnal awakening with headache (NAH) is a noteworthy issue, as it is prevalent in the general population and has been associated with several sleep and psychiatric conditions, being an indication for the occurrence of these disorders. We have previously identified that the complaint of NAH was prevalent (8.4%) and associated with sleep disorders, such as insomnia, restless leg syndrome, nightmares, and bruxism in the EPISONO cohort.

Aim: To assess the incidence and evolution of NAH in a prospective 8-year follow-up study and to identify the factors associated with the persistence of this symptom.

Methods: Data from the EPISONO cohort was collected in 2007 and the follow-up study in 2015 - both conducted at the Instituto do Sono in the city of São Paulo, Brazil. Of the 1,042 volunteers enrolled at baseline, 715 agreed to participate in follow-up (68.6%). Questionnaires and scales were applied, and in-laboratory full polysomnography was performed both in 2007 and 2015. The complaint of NAH was identified using a questionnaire and classified as frequent, occasional, or absent. Frequent NAH was defined as having symptoms at least once a week, and occasional NAH as having symptoms one to three times a month.

Results: At follow-up, 110 participants reported NAH, but only 51 (51/715, 7.1%) had frequent complaints. Of these 110 participants, 82 (82/110, 74.5%) were the same as at baseline, but only 38 (38/110, 46.3%) persisted with frequent complaints. Compared with participants whose headaches became occasional, participants with frequent complaints had a statistically significant higher prevalence of insomnia symptoms; higher insomnia severity index (8.4 ± 5.1 vs 11.2 ± 6.4, respectively); higher scores of anxiety (10.4 ± 9.3 vs 12.0 ± 10.0), and depression (10.6 ± 9.9 vs 12.0 ± 9.9) symptoms, as well as higher rates of fatigue (4.9 ± 3.1 vs 9.8 ± 5.6).

Conclusions: This study showed that frequent NAH was prevalent in the population of São Paulo both at baseline and 8 years late (follow-up), although it had reduced in 1.3%. Frequent NAH was associated with higher insomnia severity scores, higher anxiety and depression scores, and higher rates of fatigue.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
15 June 2023