Abstract Introduction Migraine is a lifelong disorder characterized by disabling headache attacks that affects about 1 billion people worldwide. Previous findings in clinical cohorts and population-based studies report that insomnia is associated with migraine. However, there are no studies on the association between migraine and insomnia in general population samples that include polysomnography. The aim of this study is to investigate whether insomnia phenotypes are associated with an increased risk of migraine in a large random general population sample. Methods A total of 1741 participants from a random sample of the Penn State Adult Cohort (52.3% women, aged 48.79± 13.56) underwent 8-hour polysomnographic evaluation. Migraine status was defined by the participant’s response to “Have you ever had migraine headaches?”, insomnia was defined by the presence of chronic insomnia lasting ≥ 1 year or complaints of difficulty falling asleep, staying asleep, nonrestorative sleep, or early morning awakening. Normal sleepers were defined by the absence of insomnia or OSA. Objective short sleep duration (SSD) was defined as 6 hours sleep based on polysomnography. Binary logistic regression was performed controlling for age, sex, race, BMI, mental health problems, i.e., depression/anxiety, years of education, smoking, alcohol consumption, caffeine use and sampling weight. Results The prevalence of migraine was 13.5%. Compared to normal sleepers, insomnia but not OSA was associated with significant risk for migraine (OR=1.47, 95%CI=1.69-2.02, p=0.018; OR:1.11, 95%CI=0.60-2.05, p=0.722, respectively). Further analysis showed that, the insomnia normal sleep duration (INSD) phenotype but not insomnia short sleep duration phenotype (ISSD) was associated with significant risk for migraine compared to normal sleepers with normal sleep duration (OR=1.60, 95%CI=1.07-2.35, p=0.02). Conclusion Our data suggest that migraine is associated with the INSD phenotype. These findings are consistent with previous reports that INSD phenotype is associated with higher levels of depression and anxiety compared to ISSD. These differences further validate the concept of phenotyping of insomnia based on objective sleep duration with therapeutic implications i.e., INSD associated with migraine may respond better to behavioral treatments than medication. Support (if any)
Pejovic et al. (2026) studied this question.