Sleep and Headaches: What Long-Term Studies Show

Last updated: October 2026

Poor sleep and headaches are linked in both directions: in a Norwegian study that followed 15,268 headache-free adults for 11 years, insomnia at the start was associated with about 40 percent higher risk of headache later (Ødegård et al., 2011). In a parallel analysis, frequent headache was associated with more than twice the odds of developing insomnia (Ødegård et al., 2013). Below is what those long-term studies found, what the sleep of people with migraine looks like, and the separate question of what the pillow does to the neck overnight.

Key takeaways

Among 15,268 headache-free adults followed for 11 years, insomnia was linked to later headache (RR 1.4) and migraine (RR 2.0) (Ødegård et al., 2011).
Among 19,271 adults without insomnia, headache on 7 or more days a month was linked to later insomnia (OR 2.2) (Ødegård et al., 2013).
A Pillowise fitting takes three measurements (shoulder width, neck circumference and neck length) and adds sleeping position and bed type to choose from seven sizes.

Does poor sleep come before headaches?

The HUNT study in Norway surveyed the same adults twice, about 11 years apart. Among 15,268 people with no headache at the first survey, those who reported insomnia had a 40 percent higher risk of headache at the second (relative risk 1.4) (Ødegård et al., 2011).

The risk ratio was 2.0 for migraine and 1.5 for tension-type headache, and the link was strongest for chronic headache. Insomnia and headache were both measured by questionnaire, so the study shows association, not cause.

Do headaches come before poor sleep?

A second analysis of the same cohort followed 19,271 adults who had no insomnia at the first survey (Ødegård et al., 2013).

Headache on 7 or more days a month was linked to more than twice the odds of insomnia 11 years later (odds ratio 2.2), and any headache to 1.5 times the odds. Chronic musculoskeletal complaints were linked to later insomnia as well (odds ratio 1.6). The authors note that the relationship between pain and sleep likely runs both ways.

How do people with migraine sleep?

A meta-analysis of 32 studies compared people with migraine against people without it (Stanyer et al., 2021).

Adults with migraine reported worse sleep quality, with a moderate to large difference (Hedges' g 0.75), and showed slightly less REM sleep in sleep-lab recordings. The included studies were case-control comparisons, so they cannot show which came first.

What does pillow height change overnight?

Headaches and neck alignment are separate questions, and the pillow belongs to the second one. In a radiographic study of 16 adults, raising the pillow from 0 to 10 to 20 cm increased T1 slope and C2-7 Cobb angle while neck tilt decreased (Kim et al., 2015).

A crossover study of 10 healthy participants paired with finite element modeling measured how heights from 110 to 170 mm shift pressure across the head and neck (Ren et al., 2016). In a pilot EMG study of 15 adults lying on their side, the height matched to shoulder width produced the lowest neck and shoulder muscle activity (Jiao et al., 2025).

Why do generic pillows miss?

A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009). No single optimal pillow height can be specified, because it depends on four variables that differ from person to person: cervical alignment, body dimension, contact pressure, and muscle activity (Lei et al., 2021).

What we measure

Pillowise is a fitted cervical pillow that licensed healthcare providers measure and dispense, made in seven sizes.

Our sleep specialists take three measurements: shoulder width, neck circumference, and neck length. Combined with sleeping position and bed type, an algorithm identifies the best-fitting pillow from seven sizes.

Shoulder width is the measurement the EMG study found mattered most. A height matched to it produced the lowest neck and shoulder muscle activity during side sleeping (Jiao et al., 2025), and body dimension is what drives the individual optimum (Tian et al., 2025).

A systematic review of 11 studies covering 309 participants identified a 7 to 11 cm unloaded central height among the parameters supporting spinal alignment and sleep comfort (Radwan et al., 2021). The size is chosen from those three measurements plus sleeping position and bed type, rather than from a single stock height.

Pillowise pillows are made from premium Dutch memory foam and certified to OEKO-TEX Standard 100, meaning every component has been tested against the standard's limits for harmful substances.

Scope

The headache studies measured sleep and headache, not pillows. No study has tested whether a fitted pillow changes headache frequency, and we make no such claim. The pillow studies are small, and the most recent systematic review found no clear advantage for any pillow type in chronic neck pain (Ghosh et al., 2025).

For providers

Headache is a common reason patients come in, and sleep is worth asking about at the same visit. A patient with frequent headaches and poor sleep may need both addressed, and new, severe, or changing headaches belong with the patient's physician.

Ask how the patient sleeps and what they sleep on. Those answers belong in the plan alongside the care you already deliver.

A fitted pillow extends the work of the visit into the hours between visits, alongside the exercise, manual therapy, and other care the provider is already delivering.

Common questions

Can poor sleep cause headaches?

It is linked to them. In 15,268 headache-free adults followed for 11 years, insomnia was associated with a 40 percent higher risk of later headache (Ødegård et al., 2011). The study shows association, not proof of cause.

Do headaches make it harder to sleep?

They are linked to later sleep problems. Headache on 7 or more days a month was associated with more than twice the odds of insomnia 11 years later (Ødegård et al., 2013), and adults with migraine reported worse sleep quality than people without it (Stanyer et al., 2021).

Can a pillow prevent headaches?

No study has shown that a fitted pillow prevents headaches, and we make no such claim. What pillow height changes is neck alignment and neck muscle activity during sleep (Kim et al., 2015; Jiao et al., 2025).

Is a contoured pillow from a store enough?

Not reliably. A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009), and no single optimal height can be specified because it depends on four variables that differ from person to person (Lei et al., 2021). A contour helps only if its height matches the person using it. That is what the fitting settles, in a provider's office.

Find a Pillowise provider or become one

Pillowise pillows are clinically measured and dispensed exclusively through licensed healthcare providers as part of broader sleep, posture, and recovery education.

To locate a Pillowise provider near you, visit: Find a Reseller

Licensed healthcare providers interested in offering Pillowise may register here: Become a Reseller

References

Ghosh, S. K., Goyal, M., & Goyal, K. S. (2025). Effect of pillow on pain, disability and sleep quality in patients with chronic neck pain: A systematic review. Rehabilitación, 59(3), 100922. https://doi.org/10.1016/j.rh.2025.100922

Gordon, S. J., Grimmer-Somers, K., & Trott, P. (2009). Pillow use: The behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy, 14(6), 671-678. https://doi.org/10.1016/j.math.2009.02.006

Jiao, R., Xiao, W., Wang, M., Yu, S., & Li, H. (2025). The impact of pillow height on neck muscle activity: A pilot study. Sleep and Breathing, 29(1), 40. https://doi.org/10.1007/s11325-024-03219-6

Kim, H. C., Jun, H. S., Kim, J. H., Ahn, J. H., Chang, I. B., Song, J. H., & Oh, J. K. (2015). The effect of different pillow heights on the parameters of cervicothoracic spine segments. Korean Journal of Spine, 12(3), 135-138. https://doi.org/10.14245/kjs.2015.12.3.135

Lei, J.-X., Yang, P.-F., Yang, A.-L., Gong, Y.-F., Shang, P., & Yuan, X.-C. (2021). Ergonomic consideration in pillow height determinants and evaluation. Healthcare, 9(10), 1333. https://doi.org/10.3390/healthcare9101333

Ødegård, S. S., Sand, T., Engstrøm, M., Stovner, L. J., Zwart, J.-A., & Hagen, K. (2011). The long-term effect of insomnia on primary headaches: A prospective population-based cohort study (HUNT-2 and HUNT-3). Headache, 51(4), 570-580. https://doi.org/10.1111/j.1526-4610.2011.01859.x

Ødegård, S. S., Sand, T., Engstrøm, M., Zwart, J.-A., & Hagen, K. (2013). The impact of headache and chronic musculoskeletal complaints on the risk of insomnia: Longitudinal data from the Nord-Trøndelag health study. The Journal of Headache and Pain, 14, 24. https://doi.org/10.1186/1129-2377-14-24

Radwan, A., Ashton, N., Gates, T., Kilmer, A., & VanFleet, M. (2021). Effect of different pillow designs on promoting sleep comfort, quality, & spinal alignment: A systematic review. European Journal of Integrative Medicine, 42, 101269. https://doi.org/10.1016/j.eujim.2020.101269

Ren, S., Wong, D. W.-C., Yang, H., Zhou, Y., Lin, J., & Zhang, M. (2016). Effect of pillow height on the biomechanics of the head-neck complex: Investigation of the cranio-cervical pressure and cervical spine alignment. PeerJ, 4, e2397. https://doi.org/10.7717/peerj.2397

Stanyer, E. C., Creeney, H., Nesbitt, A. D., Holland, P. R., & Hoffmann, J. (2021). Subjective sleep quality and sleep architecture in patients with migraine: A meta-analysis. Neurology, 97(16), e1620-e1631. https://doi.org/10.1212/WNL.0000000000012701

Tian, S., Yao, C., Wang, Y., Cao, X., Sun, Y., Wang, L., & Fan, Y. (2025). The individualized optimal pillow height and neck support design for side sleepers. Medical and Biological Engineering and Computing, 63(2), 535-544. https://doi.org/10.1007/s11517-024-03204-x