The Relationship Between Migraine Characteristics, Sleep Quality, and Insomnia: A Hierarchical Analysis

The aim of this study was to investigate the relationship between migraine characteristics, sleep quality, and insomnia severity using a hierarchical approach. A total of 50 patients diagnosed with migraine according to ICHD-3 criteria were prospectively evaluated using the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Headache Impact Test (HIT-6), and Beck Depression and Anxiety Inventories. The cohort exhibited a significant sleep burden, with 70% of participants classified as poor sleepers and 68% reporting morning headaches. Hierarchical linear regression analysis was performed in two steps; Model 1, including pain intensity (VAS) and disability (HIT-6), explained 22% of the variance in insomnia (R2=0.22, p=0,003). The addition of depressive and anxiety symptoms in Model 2 significantly increased the explained variance to 54% (ΔR²=0.32, p<0.001). Notably, in the final model, headache-related clinical parameters lost their significance, while depressive symptoms emerged as the strongest independent predictor of insomnia severity. Chronic migraineurs showed significantly higher insomnia and depression scores compared to episodic patients. These findings suggest that the relationship between migraine and sleep disturbances is predominantly driven by comorbid affective distress rather than pain characteristics alone. In conclusion, a multidisciplinary approach integrating psychological screening and mood stabilization is essential for effectively managing insomnia in the migraine population.