Beyond the Headache: Sleep-Related Symptom Burden in Children and Adolescents with Migraine and Episodic Tension-Type Headache

Background/Objectives: Sleep disturbances are frequently reported in children with primary headache disorders, but differences in sleep-related symptom profiles between pediatric migraine and episodic tension-type headache (TTH) remain unclear. This study aimed to compare Pediatric Sleep Questionnaire (PSQ) total and domain scores among children and adolescents with migraine, episodic TTH, and healthy controls and to examine whether these patterns differed according to sex and age. Methods: This analytical cross-sectional study included 197 participants aged 6–18 years recruited in Mersin, Türkiye, between 1 March 2022 and 31 December 2023. Primary headache disorders were diagnosed according to the International Classification of Headache Disorders, third edition. The headache group comprised 76 patients with migraine and 27 with episodic TTH, while 94 healthy students constituted the control group. Parents completed the validated Turkish extended PSQ. A PSQ total score ≥ 6 was considered indicative of clinically relevant sleep-related symptoms. Headache characteristics and intensity, measured using a 0–10 numerical rating scale, were also recorded. Results: A PSQ total score ≥ 6 was observed in 60/103 participants with headache (58.3%) and 26/94 healthy controls (27.7%; p < 0.001). Compared with controls, participants with headache had higher median PSQ total scores (6 [interquartile range, 4–8] vs. 4 [2–6]; p < 0.001), Breathing Problems scores (2 [1–3] vs. 1.5 [1–3]; p = 0.022), Awakening and Developmental Symptoms scores (2 [1–2] vs. 1 [0–2]; p < 0.001), and Behavioral Problems scores (1 [0–3] vs. 0 [0–1]; p < 0.001). Snoring Problems scores did not differ (p = 0.659). Both migraine and episodic TTH groups had higher PSQ total and Behavioral Problems scores than healthy controls, without significant differences between the two headache diagnoses. Compared with episodic TTH, migraine was associated with a longer headache history (p = 0.011), more frequent attacks (p = 0.021), and greater headache intensity (p = 0.013). Conclusions: Children and adolescents with migraine or episodic TTH exhibit a substantially greater burden of clinically relevant sleep-related symptoms than healthy controls. This burden is primarily reflected in overall, awakening/developmental, and behavioral symptoms rather than snoring. Sleep screening should therefore be incorporated into the clinical assessment of both pediatric migraine and episodic TTH.