# Restless legs syndrome and sleep quality in children with migraine and tension-type headache

## TL;DR

Restless legs syndrome is more common in children with migraines and is linked to worse sleep quality, suggesting it plays a role in sleep problems among these children.

## Contribution

This study is the first to compare RLS prevalence across pediatric migraine, TTH, and controls and to examine its mediating role in sleep quality.

## Key findings

- RLS was more prevalent in children with primary headaches (20.9%) than in healthy controls (8.8%).
- Children with migraine and RLS had significantly worse sleep quality than those with migraine alone.
- RLS partially explained the link between migraine and impaired sleep quality.

## Abstract

Headache disorders and sleep disturbances are common in children, with migraine and tension-type headache (TTH) being the most prevalent primary headache subtypes. Restless legs syndrome (RLS) is more frequently reported in children with migraine and may exacerbate sleep disturbances and related cognitive and quality-of-life impairments via shared neurobiological mechanisms; its prevalence across pediatric headache subtypes and its association with sleep quality remain insufficiently characterized. Therefore, this study aimed to assess the prevalence of RLS in children diagnosed with migraine or TTH and to examine its relationship with sleep quality.

In this cross-sectional study, 148 children with primary headaches (99 migraine, 49 TTH) and 148 age- and sex-matched healthy controls were included. The diagnosis of RLS was established using the pediatric criteria of the International Restless Legs Syndrome Study Group. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Group comparisons were performed to evaluate differences in RLS prevalence among headache subtypes and controls using chi-square tests, while group comparisons of continuous variables were performed using nonparametric tests. Spearman correlation was used to assess the relationship between RLS and sleep quality. In addition, mediation analysis was conducted to explore the role of RLS presence in the association between migraine and sleep quality.

RLS was detected in 20.9% of participants with primary headaches and in 8.8% of healthy controls, with a statistically significant difference between the groups (p = 0.003). Children with primary headaches had significantly higher PSQI scores compared to healthy controls (p = 0.002). Subgroup analysis demonstrated a significant difference in RLS prevalence among migraine, TTH, and control groups (p = 0.001), with RLS being most frequent in children with migraine (25.3%), followed by those with TTH (12.2%) and healthy controls (8.8%). Children with co-occurring migraine and RLS exhibited significantly poorer sleep quality compared with those with migraine alone (p < 0.001) In addition, a statistically significant positive correlation was observed between RLS symptom severity and impaired sleep quality (r = 0.571, p < 0.001). Mediation analysis indicated that RLS presence partially explained the association between migraine and impaired sleep quality (34.2% mediation, p = 0.008).

RLS was observed significantly more frequently among children with primary headaches, particularly migraine, and was significantly associated with poorer sleep quality. RLS may act as a contributing factor in the relationship between migraine and sleep impairment. These findings highlight the importance of evaluating RLS and sleep disturbances during the clinical assessment of pediatric patients with recurrent headache.