The prevalence of sleep disorders in 64 patients (38 [59%] males and 26 [41%] females; average age 10 years) with headache was evaluated in the Pediatric Neurology outpatient clinics, University of Chicago. Compared to 64 matched controls without headache, children with headache had a significantly higher prevalence of excessive daytime sleepiness, narcolepsy, and insomnia (p<0.005), but the prevalence of sleep apnea, parasomnias, and restlessness was not increased. In 18 patients diagnosed with migraine headaches, the scores for excessive daytime sleepiness and narcolepsy were significantly higher, but those for insomnia, parasomnia, sleep apnea, and restlessness were not different from non-headache controls. Medications did not alter the prevalence of any of the sleeping disorder symptoms (p>0.05). Headache patients had more frequent problems with concentration, urges to nap, sleeping at school, in the car, and a sensation of dreaming while awake (p<0.05). Headache patients with insomnia had trouble falling asleep, awakening suddenly after sleep onset, and feeling anxious about sleeping (p<0.05). Those with sleep apnea slept with mouths open (p<0.05). Headache patients had a more frequent history of seizures, dental problems, muscle disease (p<0.05), more frequent morning headaches, causing awakening, and nighttime arousals (p<0.005). 
COMMENT. A case history of a child presenting with headache should inquire about daytime sleepiness, narcolepsy, and insomnia. Children with headaches have more frequent symptoms of primary sleep disorders, and treating the sleep disorder may benefit the headache and improve the quality of life. Both headache and sleep disorders can be triggered by changes in neurotransmitters, and a fall in serotonin levels will affect REM sleep.