Evaluation of contributing factors to restless legs syndrome in migraine patients

Abstract

Recent studies have provided evidence for a positive association between migraine and restless legs syndrome (RLS), although the exact mechanisms and contributing factors remain unclear. A cross-sectional, case-control study was conducted, including patients with migraine (n = 262) and headache-free control subjects (n = 163). Migraine was diagnosed according to International Classification of Headache Disorders II criteria. RLS diagnosis was made based on four essential criteria as described by the International Restless Legs Syndrome Study Group. All patients completed the Migraine Disability Assessment (MIDAS) questionnaire, Beck Depression Inventory (BDI)-II scores, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). A total of 210 blood samples were collected to correlate various parameters with RLS. RLS frequency was significantly greater in patients with migraine than in controls (13.7 vs. 1.8%). Migraine patients with RLS had high scores for MIDAS, BDI-II, PSQI, and ESS compared with those without RLS. In addition, migraine patients with RLS had a high rate of smoking and RLS family history, as well as increased levels of serum phosphorus and urea nitrogen compared with those without RLS. However, there was no difference in serum iron and ferritin levels between the groups. In migraine patients, logistic regression analysis revealed that positive RLS family history, BDI-II, ESS, and serum phosphorus levels were significant RLS predictors. Our study confirmed a positive association between RLS and migraine. RLS comorbidity in migraine patients was associated with insomnia, daytime sleepiness, depressive symptoms, headache-related disability, and increased serum phosphorus levels. These findings may provide a better understanding of RLS pathogenesis in migraine.

Migraine and sleep disorders

“…Even if two studies have reported a linkage between migraine with aura (MA) and RLS in two different families [5,6], D'Onofrio et al [7] have recently remarked that the prevalence of RLS in 63 patients with pure MA was 9.5 %, similar to that observed in Italian headache-free subjects (8.3 %). Finally, Suzuki et al [8] in a cross-sectional case-control study, compared 262 patients with migraine and 163 headache-free control subjects, confirming higher RLS frequency in the first group (13.7 vs. 1.8 %) and highlighting that migraineurs with RLS experience more frequently impaired sleep quality, sleep latency and sleep disturbances, use more sleeping medication and have daytime dysfunctions.…”

Migraine: risk factor and comorbidity

“…Many studies have investigated the relationship between headaches in general and sleep problems, some focusing on migraine and showing a strong linkage with restless legs syndrome [2,3,12,13], excluding MA [14]. The association between narcolepsy and migraine remains controversial [2].…”

Does pramipexole treatment improve headache in patients with concomitant migraine and restless legs syndrome?

“…A growing body of evidence suggests a strong link between migraines and restless legs syndrome (RLS), [1][2][3][4] which was recently confirmed by a large prospective population-based study consisting of 31,370 women. This study demonstrated that women with migraines with and without aura have an increased risk for developing RLS.…”

“…4 Central dopaminergic dysfunction in the hypothalamic A11 area has been postulated in both migraines and RLS, 6,7 and it is likely to participate in the development or worsening of both symptoms because the A11 dopaminergic nucleus inhibits firing in the trigeminocervical complex, 7 a key region for the transmission of migraine information from the head and orofacial structures to the hypothalamus and brain. Moreover, the A11 nucleus also sends direct inhibitory projections to preganglionic sympathetic neurons and the dorsal and anterior horns in the spinal cord, innervating skeletal muscle.…”