Cognitive impairment and short sleep duration were associated with headache in Chinese middle-aged and elderly adults, with associations varying by sex, and a significant interaction observed between sex and sleep duration.
The overall prevalence of headache in the study population was 18.76%, with a substantially higher rate in females than in males.
Poor cognitive ability was associated with significantly increased odds of headache compared to excellent cognitive ability.
Both moderate and long sleep durations were associated with reduced odds of headache compared to short sleep duration (less than 6 hours).
Sex-stratified analyses showed approximately linear associations in males but distinct nonlinear patterns in females for both cognitive ability and sleep duration.
Nonlinear relationships and threshold effects between sleep duration, cognitive ability, and headache were identified using restricted cubic spline models and two-stage linear regression.
This research suggests that among middle-aged and older adults in China, both poorer thinking and memory abilities and sleeping less than 6 hours per night are linked to a higher likelihood of experiencing headaches. The study analyzed data from over 13,000 people and found that headaches were nearly twice as common in women (about 1 in 4) as in men (about 1 in 8). People with poor cognitive function had about 35% higher odds of headache compared to those with excellent cognitive function, and people who slept a moderate or longer amount (6 or more hours) had roughly half the odds of headache compared to short sleepers. The relationship between these factors and headaches was not always simple and straight-line. For the overall group, cognitive ability showed an inverted U-shaped relationship with headache risk, and sleep duration showed a U-shaped relationship, meaning both extremes of sleep (too little or very long) were associated with higher headache risk. Importantly, these patterns differed between men and women: men showed more straightforward linear patterns, while women showed more complex nonlinear patterns. Sleep duration also interacted significantly with sex in relation to headache risk. This research suggests that sleep habits and cognitive health may both be relevant factors in understanding why some people experience headaches more than others, particularly in older populations. The findings also highlight that the same factors may affect men and women differently, which could be important for how headache prevention and management strategies are developed. Because this was a cross-sectional study (a snapshot in time), it cannot confirm whether poor cognition or poor sleep directly cause headaches, but it does show these factors are meaningfully associated.
Zhang M, Zhao E, Sun G. (2026). Association of cognitive ability and sleep duration with headache : insights from a Chinese middle-aged and elderly population.. BMC public health. https://doi.org/10.1186/s12889-025-26122-5