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Both conditions substantially impair quality of life and daily functioning, potentially because of shared pathophysiological mechanisms. In this study, we investigated the association between migraine frequency and insomnia severity and examined the impact of aura, psychological factors, and restless legs syndrome (RLS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross\u2010sectional controlled study included 2155 participants (1954 individuals with migraine and 201 controls) who visited the neurology outpatient department of a tertiary medical center between January 2019 and October 2023. Migraine diagnosis adhered to the International Classification of Headache Disorders, 3rd edition criteria, with all participants evaluated by a board\u2010certified neurologist and headache specialist. Insomnia severity was assessed using the Insomnia Severity Index (ISI), and psychological factors were measured using the Beck Depression Inventory\u2010II and Hospital Anxiety and Depression Scale. RLS was diagnosed as per international criteria, and individuals with migraine were stratified by headache frequency (1\u20137, 8\u201314, or \u226515\u2009days\/month) and aura status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      High migraine frequency was associated with increased ISI scores (adjusted regression coefficient [\u03b2]\u2009=\u20090.75, 95% confidence interval [CI], 0.50\u20131.01) and increased prevalence of clinical insomnia (ISI \u2265 15) (adjusted odds ratio [aOR]\u2009=\u20091.34; 95% CI, 1.17\u20131.53) after controlling for demographic, lifestyle, and clinical factors. In the univariate analysis, patients with migraine with aura showed higher ISI scores than those without aura (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001); however, this difference was no longer significant after adjustment for migraine frequency, depression, anxiety, RLS, and other confounders (adjusted \u03b2\u2009=\u20090.48; 95% CI, \u22120.24 to 1.20;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.191). Multivariable analyses revealed significant associations between ISI total score and depression (adjusted \u03b2\u2009=\u20090.21; 95% CI, 0.17\u20130.24), anxiety (adjusted \u03b2\u2009=\u20090.34; 95% CI, 0.27\u20130.41), and RLS (adjusted \u03b2\u2009=\u20091.02; 95% CI, 0.53\u20131.51). RLS prevalence was significantly higher in the migraine group than in the control group (32.4% vs. 12.9%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Migraine frequency showed a graded association with insomnia severity, with additional independent contributions from psychological factors and RLS, but not from aura status. These findings underscore the multifactorial nature of sleep disturbances in migraine and the need for comprehensive management strategies that address both headache\u2010specific factors and comorbid conditions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.15055","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T11:55:26Z","timestamp":1758282926000},"page":"633-645","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Insomnia severity in migraine: The role of headache frequency, aura status, and comorbidities\u2014A cross\u2010sectional study"],"prefix":"10.1111","volume":"66","author":[{"given":"Kuang\u2010Heng","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Neurology Tri\u2010Service General Hospital, National Defense Medical University  Taipei 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