RLS was observed significantly more frequently among children with primary headaches, particularly migraine, and was significantly associated with poorer sleep quality, with RLS partially mediating the association between migraine and sleep impairment.
Key Findings
Results
RLS prevalence was significantly higher in children with primary headaches compared to healthy controls.
RLS was detected in 20.9% of participants with primary headaches versus 8.8% of healthy controls.
The difference between groups was statistically significant (p = 0.003).
The study included 148 children with primary headaches and 148 age- and sex-matched healthy controls.
Diagnosis of RLS was established using the pediatric criteria of the International Restless Legs Syndrome Study Group.
Results
RLS prevalence differed significantly across migraine, TTH, and control groups, being highest in children with migraine.
Subgroup analysis demonstrated a significant difference in RLS prevalence among migraine, TTH, and control groups (p = 0.001).
RLS was most frequent in children with migraine (25.3%), followed by those with TTH (12.2%) and healthy controls (8.8%).
The migraine group comprised 99 children and the TTH group comprised 49 children.
Group comparisons were performed using chi-square tests.
Results
Children with primary headaches had significantly poorer sleep quality compared to healthy controls.
Children with primary headaches had significantly higher PSQI scores compared to healthy controls (p = 0.002).
Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).
Group comparisons of continuous variables were performed using nonparametric tests.
Results
Children with co-occurring migraine and RLS exhibited significantly poorer sleep quality than those with migraine alone.
The difference in sleep quality between children with migraine plus RLS versus migraine alone was statistically significant (p < 0.001).
This finding was identified through subgroup analysis within the migraine group.
Results
RLS symptom severity was significantly positively correlated with impaired sleep quality.
A statistically significant positive correlation was observed between RLS symptom severity and impaired sleep quality (r = 0.571, p < 0.001).
Spearman correlation was used to assess the relationship between RLS and sleep quality.
Results
RLS presence partially mediated the association between migraine and impaired sleep quality.
Mediation analysis indicated that RLS presence partially explained the association between migraine and impaired sleep quality.
The mediation proportion was 34.2% (p = 0.008).
This was identified through formal mediation analysis conducted as part of the study design.
What This Means
This research suggests that children who suffer from headaches — particularly migraines — are more likely to also have restless legs syndrome (RLS), a condition causing uncomfortable sensations in the legs with an urge to move them, especially at night. Among 148 children with headaches, about 1 in 5 had RLS, compared to fewer than 1 in 10 healthy children of the same age and sex. The highest rates were seen in children with migraines (about 1 in 4), followed by children with tension-type headaches, and then healthy controls.
This research also suggests that having both migraines and RLS together is particularly harmful to sleep quality. Children with both conditions slept significantly worse than those with migraines alone, and more severe RLS symptoms were strongly linked to worse sleep. Statistical analysis estimated that RLS accounts for about one-third (34.2%) of the reason why children with migraines tend to sleep poorly, suggesting it is an important but not the only contributing factor.
These findings matter because sleep problems in children can affect their thinking, mood, and overall quality of life. The study highlights that when doctors evaluate children who have recurring headaches, they should also screen for RLS and sleep disturbances, as addressing RLS might help improve sleep quality in these children. The study was cross-sectional, meaning it captured a snapshot in time and cannot prove that RLS causes worse sleep in headache patients, but it points to an important connection worth investigating further.
Altın H, Ay F, Kutluk M. (2026). Restless legs syndrome and sleep quality in children with migraine and tension-type headache.. PeerJ. https://doi.org/10.7717/peerj.20925