Stanford Report Online

Stanford Report, January 21, 2004
Chronic morning headaches, depression may share link
Surprising findings reveal unmet health problems


Waking up in the morning with a headache may indicate more than a bad dream or a wild office party the night before. A researcher at the medical school has found that chronic morning headaches are good indicators of depressive disorders and a variety of other ailments.

The unique study, which appeared in the Jan. 13 issue of the Archives of Internal Medicine, also showed that these morning headaches affect one in 13 people.

"This number means that millions of people are suffering," said Maurice Ohayon, MD, PhD, associate professor of psychiatry and behavioral sciences, noting that the prevalence of morning headaches had not been well documented prior to this study. "In medicine we’re concerned with disorders that are much less common. Clearly, this one is very important."

People suffering from chronic morning headaches awaken with pain every day or numerous times a week and typically feel tired, irritable and anxious during the day. "They often feel under pressure, which can lead to strained relationships at work and home," said Ohayon. "These headaches certainly impact their quality of life."

Waking up with a headache has traditionally been associated with sleep disorders, and past studies have reported a high association between the headaches and obstructive sleep apnea syndrome. No previous study had examined other diseases and disorders — such as mental disorders — that may cause chronic morning headaches, and Ohayon’s study aimed to explore this association in the general population.

In his study, Ohayon conducted a telephone survey with adults in five countries (the United Kingdom, Germany, Italy, Portugal and Spain). More than 18,000 people were chosen as a representative sample of 206 million Europeans.

Participants answered questions pertaining to sleep habits, morning headaches, clinical disorders, controlled substance use, and sleep and mental disorders. Ohayon stressed that the study focused on chronic headaches as opposed to once-in-awhile events.

After analyzing the data, Ohayon found that 7.6 percent of the respondents had awakened with headaches. Chronic morning headaches were reported as "daily" by 1.3 percent of the people surveyed, "often" by 4.4 percent of the survey sample and "sometimes" by 1.9 percent of the sample.

When examining the relationship between the headaches and frequently reported diseases, Ohayon found the most significant factors associated with the headaches were anxiety and depressive disorders (28.5 percent of people with both disorders had chronic morning headaches vs. 5.5 percent of people without) — not sleep-related breathing disorders.

"There has been a big debate in the sleep field about these headaches being strongly associated with sleep apnea, and we invalidate this possibility," said Ohayon. "Sleep disorders are associated, but chronic morning headaches are not specific to sleep apnea."

Ohayon also found a higher prevalence of the headaches in people who reported musculoskeletal diseases, heart disease, thyroid disease, hypertension and sleep-related breathing disorders than those who did not.

He said his most surprising finding focused not on the causes of the disorder but on the median duration of the headaches, which he determined was 42 months.

"This was much higher than what I expected and it means that people aren’t being treated," Ohayon said. "It’s clear that there is a population whose health needs are not being addressed."

Ohayon said physicians should be aware that morning headaches are typically related to another identifiable disorder, and physicians should conduct a thorough interview with their patients to identify possible factors.

Ohayon’s study was supported by an unrestricted educational grant from the Sanofi-Synthelabo Group, a pharmaceutical company, and a grant from the Fonds de la Recherche en Sante du Quebec (the Medical Research Council of Quebec, Canada).

Study finds link between sleep apnea, depression (11/5/03)

Link found between depression and chronic pain (1/22/03)