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Given links between sleep and pain, characterizing sleep among youth with continuous headache may inform intervention targets. This study was undertaken to describe the sleep characteristics of a sample of treatment\u2010seeking adolescents with continuous headache and contextualize these data by comparing the sleep\u2013wake behavior of youth with continuous headache to youth with noncontinuous headaches and healthy teens. We hypothesized that youth with continuous headache would have worse sleep quality than youth with noncontinuous headaches and healthy adolescents. Secondary analyses tested associations between sleep and psychosocial functioning among youth with continuous headache.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross\u2010sectional observational study focused on a pilot sample of 26 adolescents (aged 12\u201317\u2009years) who reported continuous headache for at least 1 month prior to presenting for interdisciplinary specialty care. Study enrollment ran from October 2019 to August 2020. Data at initial study visits were collected regarding participant\/family demographics, headache characteristics and diagnosis (using International Classification of Headache Disorders, 3rd edition criteria), and headache\u2010related disability (as measured using the PedMIDAS). Participants also completed questionnaires regarding their sleep behavior (Adolescent Sleep Wake Scale [ASWS]), insomnia symptoms (Pediatric Insomnia Severity Index), sleep hygiene (Adolescent Sleep Hygiene Scale), and mood\/anxiety symptoms (Patient\u2010Report Outcome Measure Information System, Anxiety and Depressive Symptoms scales). Participants' scores on sleep measures were described in the context of published clinical cutoffs. Scores on the ASWS were also compared to those of an age\u2010, sex\u2010, and race\u2010matched sample of 26 youth with noncontinuous headaches, and published norms for adolescents without chronic pain. Finally, we examined associations among sleep variables, PedMIDAS scores, and psychological symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      More than 60% of youth with continuous headache reported clinically elevated insomnia symptoms, and more than one third reported clinically meaningful difficulties with sleep hygiene. ASWS scores were not significantly different between participants with continuous headaches and youth with noncontinuous headaches due to migraine. ASWS \u201cfalling asleep and re\u2010initiating sleep\u201d (mean\u2009=\u20094.1 [SD\u2009=\u20091.1], normative mean\u2009=\u20094.7,\n                      <jats:italic>t<\/jats:italic>\n                      [25] = \u22123.1,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005) and \u201creturn to wakefulness\u201d (mean\u2009=\u20092.1 [SD\u2009=\u20091.1], normative mean\u2009=\u20093.3,\n                      <jats:italic>t<\/jats:italic>\n                      [25] = \u22125.5,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) subscale scores were worse than those of youth without chronic pain conditions. Insomnia symptoms and sleep hygiene difficulties were significantly associated with youth anxiety symptoms. ASWS scores on the \u201cfalling asleep and re\u2010initiating sleep\u201d subscale were associated with youth depressive symptoms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High rates of clinically meaningful sleep difficulties were identified in youth with continuous headache. Although sleep\u2013wake difficulties were not significantly different from a comparison sample of youth with noncontinuous headaches, future research is needed to examine the role of sleep in long\u2010term clinical outcomes for youth with high\u2010frequency headache conditions like continuous headache. Screening and targeted interventions focused on sleep difficulties should be incorporated into treatment for these youth.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.14990","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T07:04:23Z","timestamp":1750143863000},"page":"1766-1775","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Characterizing sleep, headache\u2010related disability, and psychological functioning among adolescents with continuous headache: A pilot study from a tertiary clinical setting"],"prefix":"10.1111","volume":"65","author":[{"given":"Ellie C.","family":"Adam","sequence":"first","affiliation":[{"name":"Division of Behavioral Medicine and Clinical Psychology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio 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College of Medicine  Cincinnati Ohio USA"},{"name":"Headache Center Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1598-7536","authenticated-orcid":false,"given":"Andrew D.","family":"Hershey","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati College of Medicine  Cincinnati Ohio USA"},{"name":"Headache Center Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"Division of Neurology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marielle","family":"Kabbouche","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati College of Medicine  Cincinnati Ohio USA"},{"name":"Headache Center Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"Division of 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