Background and aims: Tension type headache (TTH) is most prevalent in women than in men (ratio about 3:1). Our aim was to assess gender differences in those variables associated with headache burden in TTH. Methods: Individuals diagnosed with TTH according to the International Headache Classification (ICHD-III) participated. Primary headaches, medication overuse headache, whiplash or fibromyalgia were the exclusion criteria. The burden of headache was assessed with the Headache Disability Inventory. Headache features were collected with a 4-weeks diary. Sleep quality was assessed with the Pittsburgh Sleep Quality Index. The Hospital Anxiety and Depression Scale assessed anxiety/depressive symptoms. Finally, trait and state anxiety levels were evaluated with the State-Trait Anxiety Inventory. Hierarchical regression analyses were conducted to determine the associations between the burden of headache with the remaining variables in men and women. Results: Fifty-nine men and 153 women (n=212) participated. The regression analyses reported that sleep quality explained 31.1% of the physical burden and 36.7% of emotional burden (both, P<0.001) in men. The regression analyses found that headache intensity and depression explained 21.8% of the physical burden, whereas depression, headache intensity, frequency, duration and trait levels of anxiety explained 46.6% of the emotional burden of headache (both, P<0.001) in women. Conclusions: We observed some gender differences in the variables associated with headache burden in TTH. Sleep quality was the variable associated with the burden of headache in men with TTH; whereas headache features, depression and anxiety were associated with the headache burden in women with TTH.

SLEEP QUALITY IS ASSOCIATED WITH THE BURDEN OF HEADACHE IN MEN, BUT NOT IN WOMEN, WITH TENSION TYPE HEADACHE