title: Psychological Mechanisms, Interventions, and Clinical Outcomes in Sleep-Related Headaches
Creators: name: Sullivan, Daniel P
Publisher: name: Griffith University
Year: 2022
Subjects: subject: Sleep-Related Headaches
subject: psychological mechanisms
subject: Sleep disorders
subject: Sleep problems

description: Sleep problems are one of the most frequent triggers of primary headaches such as migraine and tension-type headache, second only to stress. Whilst the relationship between various sleep disorders, and poor sleep in general has been well established, to date there has been a paucity of research examining psychological mechanisms of sleep-related headaches. This thesis sought to examine the following research questions about sleep-related headaches, in the context of the discipline of Clinical Psychology: Study One (Chapter Two) – What is causing the problem? What are the psychological mechanisms underpinning sleep-related headaches? Study Two (Chapter Three) – What are the consequences of the problem? Do insomnia, headaches and co-morbid insomnia and headaches predict poor therapeutic response to psychotherapy? Study Three (Chapter Four) – What can we do about the problem? Do psychological sleep interventions help both sleep and headaches? Chapter Five – What does the future hold? Exploring the next directions in sleep and headache research. Study One demonstrated that both maladaptive sleep beliefs and sleep safety behaviours are associated with greater headache frequency, mediated by sleep quality. This study also provided preliminary empirical support for sleep-related triggers in the Trigger Avoidance Model of Headaches. It was found that greater efforts to avoid both inadequate and excessive sleep, and fatigue and tiredness were associated with greater headache frequency, mediated by increased trigger sensitivity. Study Two demonstrated that in adults attending the Griffith University Psychology Clinic, the presence of frequent insomnia or headache symptoms at the initial session was highly predictive of an inadequate response to psychotherapy (remaining clinically symptomatic at the final session of therapy). This effect was found to be even more pronounced in those with both insomnia and headaches. Study Three was a systematic review and meta-analysis, which assessed the literature on the use of psychological sleep interventions for headaches. The review found only four studies which met criteria for inclusion. In pooling the three studies which were suitable for meta-analysis, a random-effects model demonstrated that psychological sleep interventions (such as Cognitive Behaviour Therapy for Insomnia) reduced the frequency, but overall, not the intensity of primary headaches. Given the small number of studies and overall patients included, this should not be considered a conclusive finding. Taken together, the findings of this thesis demonstrate both cognitive and behavioural factors are at play in sleep-related headaches, and that insomnia and headaches may blunt the therapeutic response to psychotherapy. Reassuringly, however, psychological sleep interventions are known to improve sleep, and this thesis found they also reduce headache frequency. This may mitigate some of the negative effects of sleep and headache problems on psychotherapeutic response. Future research directions (discussed in Chapters Five and Six) should examine the role of sleep behaviours in clinical samples of chronic migraine patients, and assess neurophysiologic markers of sleep-related headaches and subsequent response to therapy (such as EEG power spectrum and sleep architecture), and the pursuit of integrative and modular headache treatments tailored to co-occurring conditions/problems. The original contributions to knowledge from this thesis are the implication of maladaptive sleep beliefs in the sleep-headache relationship, that insomnia and headaches impair psychotherapeutic response – an effect which is additive when both occur, and the first systematic review and meta-analysis of psychological sleep interventions for headaches.