Abstract text (incl. figure legends and references)

Migraine and sleep disorders are frequently comorbid and linked by a mutual dependance, possibly representing the expression of a common pathogenic process. This study aimed to analyze the relationship between headache features (migraine frequency and severity, presence of migraine equivalents, use and efficacy of medications) and sleep in pediatric migraine.

Parents of children and adolescents with migraine completed two standardized sleep assessment questionnaires, the Children"s Sleep Habits Questionnaire (CSHQ) and the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), and answered questions about headache characteristics in their children. The presence of sleep disorders was defined according to CSHQ"s total score.

The CSHQ revealed a sleep disturbance in 72.9% of 140 subjects, but only 5.0% had already received a diagnosis. Patients with sleep disturbances presented statistically significant higher headache frequency (p=0.031) and higher prevalence of migraine equivalents (p=0.007). A higher CSHQ"s total score was associated with higher frequency of severe attacks (p=0.012) and lower efficacy of acute medications (p=0.003). Significant positive correlations of sleep onset delay (p=0.006), sleep duration (p=0.005) and nightwakings (p=0.047) subscales with migraine frequency also emerged. Only 2.8% of patients reached a clinically significant score in the ESS-CHAD.

Our findings indicate that sleep disorders are highly prevalent in pediatric migraine and frequently associated with higher headache severity and lower response to acute therapy, but often remain underdiagnosed. Given the relationship between sleep and migraine characteristics, improving sleep quality, through sleep hygiene interventions and specific treatments, could help to reduce migraine intensity and disability and vice versa.