Answer: Headaches are extremely common. Nearly everyone has a headache occasionally. When they occur repeatedly, they are a symptom of a headache disorder. The most common headache disorder is tension-type headache. 1 adult in 20 has a headache nearly everyday.

Migraine is also very common affecting at least 1 adult in every 7 in the world. It is up to 3 times more common in women than men and mostly affects those aged between 35 and 45 years.

Headache disorders can cause substantial personal suffering, impaired quality of life and high financial cost. Repeated headache attacks, coupled with the fear of another attack can affect family life, social life and employment. Despite this, many individuals tend to perceive headaches as a minor or trivial complaint. As a result, the physical, emotional, social and economic burdens of headaches are poorly acknowledged.

For the vast majority of people suffering from headache, effective treatment requires awareness of the problem, correct diagnosis, avoidance of mismanagement, appropriate lifestyle modifications and informed use of pharmaceutical remedies. Commonly used preventive strategies include medications and non-medication treatments for headache such as biofeedback, and relaxation. Additionally, there are dedicated psychological approaches for headache problems including Cognitive Behaviour Therapy for headaches.

Disordered sleep, poor sleep quality, and insufficient or excessive sleep duration are known triggers of primary and secondary headaches. Given this, it is plausible that improving sleep will subsequently reduce headache activity. Sleep problems and headache possibly co-occur as a result of the dysregulation of shared brain regions, i.e., issues with sleep trigger headaches, and headaches can lead to poor sleep. Research has shown that sleep disturbance may worsen pain symptomatology, as well as decreasing the effectiveness of central pain inhibitory processes. They found that two days of stress or inadequate sleep were associated with higher incidence of headaches, and conversely, two days of lowered stress and adequate sleep acted as a protective factor. Logically if dysregulated or disrupted sleep leads to headaches, improving sleep should reduce headache frequency and/or intensity. And whilst sedative/hypnotic medications play a role in the management of certain sleep problems, where the aetiology of the issue is psychophysiological, such as insomnia, psycho-behavioural interventions are the initial treatment of choice.

Answer: Both behavioural and cognitive strategies exist for treating insomnia and poor sleep habits; when used together these are referred to as Cognitive Behaviour Therapy for Insomnia (CBT-i). Strategies include:

1. Sleep restriction-By restricting the opportunity for sleep, a greater sleep pressure (the drive to sleep) is accumulated which consequently increases sleep efficiency.
2. Stimulus control-aims to break the association between the sleeping environment and wakefulness that develops with insomnia and poor sleep habits.
3. Sleep hygiene-encompasses optimal lifestyle and environmental factors for sleep. Some lifestyle factors include avoiding night-time alcohol, nicotine and caffeine prior to bed. Keeping excessive light and noise out of the bedroom are examples of environmental factors which are targeted in sleep hygiene education.

CBT-i is indicated as a primary treatment of choice for treating insomnia, and has been demonstrated to increase sleep. Given the role of sleep in pain, correcting poorly regulated sleep with psychological interventions may reduce headache frequency also.