Regarding specific sleep hygiene behaviors, over half of the entire sample endorsed frequently or always using their bed for something other than sleep or sex (62.0%), doing

something that may wake them up before bedtime this website (61.3%), going to bed at different times each day (56.8%), doing important work before bed (56.5%), and thinking, planning, or worrying in bed (55.8%). However, the MANOVA failed to reveal any significant between-group differences across the 13 specific sleep behaviors, Wilks’ lambda = 0.949, F(13,269) = 1.116, P = not significant. As shown in Table 1, migraineurs reported higher levels of both depression and anxiety than controls. These mean differences were replicated in comparisons click here of group proportions meeting clinical cut-offs for moderate or greater symptomatology on both the PHQ-9 and GAD-7 (scores ≥10). Specifically, 39.7% of migraineurs vs 20.2% of controls reported clinically significant depression (P = .001), and 34.6% of migraineurs vs 18.4% of controls reported clinically significant anxiety (P = .004). As such, depression and anxiety scores were entered as covariates in the subsequent regression analyses. As depicted in Table 2, sleep quality, depression symptomatology, and anxiety symptomatology were all significantly predictive of migraine frequency in the

univariate analyses. Daytime sleepiness and sleep hygiene were not predictive of headache frequency and were thus not analyzed in the adjusted analyses with covariates. After first adjusting for depression and anxiety, the association between sleep quality

and migraine frequency remained significant (Block 2 ΔR2 = 5.3%, P = .04). None of the sleep disturbance or psychiatric GPX6 variables were significantly associated with headache severity. As shown in Table 3, both sleep quality and sleep hygiene were associated with headache-related disability, as were symptoms of depression and anxiety. In the adjusted analyses, depression and anxiety were first entered as covariates, and a stepwise entry procedure was employed with sleep quality and sleep hygiene in the second block (P < .05 required for entry into the model) in order to assess their relative contributions to disability. The stepwise procedure selected only sleep quality into the covariate-adjusted model, which accounted for 5.8% of unique variance in headache-related disability after controlling for depression and anxiety (P = .02). The current study examined the relative importance of 3 distinct sleep disturbance variables (ie, sleep quality, daytime sleepiness, sleep hygiene) pertinent to insomnia among young adult episodic migraineurs, a population of interest because of their high rates of migraine,[40, 41] disturbed sleep,[42, 43] and psychiatric comorbidities.[41, 44] Of additional interest was delineating any potential relationship between sleep disturbance and affective symptomatology.