Association of sleep and dyslipidemia with migraine incidence in a cohort of 309,475 participants

Poor sleep quality is an essential factor in various neurological disorders. However, prospective evidence and the underlying biological mechanisms of sleep quality in patients with new-onset migraines are lacking. This study examined the prospective association between sleep quality, migraine incidence, and the underlying biological mechanisms. This prospective cohort study included 309,475 individuals without headaches at baseline and with complete sleep behaviour measurements from the UK Biobank. Sleep quality was assessed based on chronotype, sleep duration, insomnia, snoring, and excessive daytime sleepiness. Cox proportional hazards models were used to estimate the association between sleep quality scores and migraine incidence. Mediation analyses were performed to investigate the potential mediating effects of metabolic syndrome and its components, biomarkers, and metabolites on this association. Over a median follow-up of 13.6 years, 3,891 participants (1.3%) developed migraines. The Cox model results revealed a significant negative relationship between baseline sleep scores and migraine incidence. Sleep scores were defined such that higher scores indicated better sleep quality. Higher sleep scores were associated with a decreased risk of new-onset migraines (fully adjusted hazard ratio: 0.88, 95% confidence interval [CI]: 0.85 -0.90 per unit increase). Additionally, adequate sleep duration, an absence of insomnia, and excessive daytime sleepiness were independently associated with a significantly reduced migraine risk. Dyslipidemia mediated the association between sleep score and migraine incidence, with a mediation proportion of 3.28% (95% CI 1.37-5%). Our study revealed an association between sleep quality and migraine risk and the potential role of dyslipidemia in mediating this association.