Sleep Duration and Migraine: What a 6,267-Person Study Found

What the Study Looked At

The data come from the HeAD-US study (Headache Assessment via a Digital Platform), a survey of adult users of the Migraine Buddy app completed between September and November 2023. The research team included headache specialists from Brigham and Women's Hospital, Albert Einstein College of Medicine, and the University of California, Irvine.

Participants reported how many hours they usually sleep each night, along with details about their headaches. They also completed three standard questionnaires: the Perceived Stress Scale-4, the Migraine Disability Assessment (MIDAS), and the Patient Health Questionnaire-4, which screens for anxiety and depression. Migraine was confirmed using the International Classification of Headache Disorders (ICHD-3) criteria.

Sleep was sorted into three groups: short (6 hours or less), normal (7 to 9 hours), and long (10 hours or more). The normal group served as the comparison.

Short Sleep and Migraine Burden

Compared with people sleeping 7 to 9 hours, those sleeping 6 hours or less had about 11% more expected monthly headache days (adjusted incidence rate ratio 1.11, 95% CI 1.05 to 1.17). Their expected MIDAS disability scores were about 14% higher (1.14, 95% CI 1.08 to 1.20).

Those are modest increases for any one person. Because short sleep is common, even a modest difference affects a large number of people.

Long Sleep Showed the Larger Link

People who reported sleeping 10 hours or more had about 27% more expected monthly headache days than normal sleepers (1.27, 95% CI 1.07 to 1.51). Their expected MIDAS scores were 66% higher (1.66, 95% CI 1.41 to 1.96).

That disability gap is the largest effect in the study. The wider confidence intervals for the long sleep group suggest fewer people fell into it, so the exact size of the effect is less certain than for short sleep, even though the direction is clear.

It is not clear which way the cause runs. Someone with frequent, disabling migraine attacks may spend more hours in bed because of the attacks, rather than the other way around. Long sleep can also travel with depression, fatigue, and other health problems. A single survey cannot separate these explanations.

Where Stress Fits In

The researchers also looked at perceived stress. In their analysis, stress statistically accounted for about 48% of the link between short sleep and monthly headache days, and about 30% of the link between long sleep and monthly headache days.

One reading is that poor sleep and stress feed into each other, and both add to migraine burden. The authors are careful with the wording: stress accounted for part of the association, but not all of it. Because sleep, stress, and headache days were all measured at the same moment, this analysis shows how the numbers overlap. It cannot confirm that stress sits on a causal path between sleep and migraine.

Limits of This Study

This is a large, well-analyzed survey, and it still has the usual limits of cross-sectional data.

• One point in time. Sleep and migraine were measured together, so the study shows association rather than cause, in either direction.
• Self-reported sleep. Participants estimated their usual nightly sleep. Nobody wore a sleep tracker or had a sleep study, and people often misjudge how long they sleep.
• App users. Everyone was recruited through a migraine tracking app, and more than 9 in 10 were women. People who track their attacks may differ from the wider migraine population.
• No sleep quality or disorders. Hours of sleep say nothing about how restful that sleep was, or whether conditions such as insomnia or sleep apnea were present.
• Industry involvement. Two of the authors list affiliations with APTAR, and the survey ran through the Migraine Buddy app.

The study also did not test whether changing sleep changes migraine. That would need a trial where people adjust their sleep and are followed over time.

What This Means for You

Keeping sleep in a steady middle range, with regular bed and wake times, is standard advice from headache specialists, and this study fits with it. The findings suggest that both ends of the range deserve attention.

If you regularly sleep 6 hours or less, or 10 hours or more, it is worth raising with your clinician. Sleep disorders such as insomnia and sleep apnea are common in people with migraine and can be treated, and depression can show up as long sleep and low energy. Tracking your sleep hours alongside your attacks for a few weeks can make that conversation more useful.

For more on how the two affect each other, including the weekend lie-in pattern and the evidence on melatonin, see our guide to sleep and migraine.