Sleep and Headache

Abstract

Headache has been linked to a wide range of sleep disorders that may impact headache management. There are no evidence-based guidelines, but the authors believe that literature supports the following clinical recommendations: 1. Diagnose headache according to standardized criteria. Specific diagnoses are associated with increased risk for specific sleep and psychiatric disorders. 2. Collect sleep history in relation to headache patterns. Screening questionnaires and prediction equations are cost-effective. 3. Rule out sleep apnea headache in patients with awakening headache or higher-risk headache diagnoses (cluster, hypnic, chronic migraine, and chronic tension-type headache); patients with signs and symptoms of obstructive sleep apnea warrant polysomnography and treatment according to sleep medicine practice guidelines. There is no evidence for suspending conventional headache treatment in suspected or confirmed cases of sleep apnea. Treatment of sleep apnea with CPAP may improve or resolve headache in a subset of patients. The impact on sleep apnea headache of other treatments for sleep apnea (eg, oral appliances, surgery, weight loss) is largely untested. At a minimum, sedative-hypnotic drugs should be avoided in suspected apneics until the sleep apnea is treated. 4. Among patients with migraine and tension-type headache, insomnia is the most common sleep complaint, reported by one half to two thirds of clinic patients. Patients who suffer from chronic migraine or tension-type headache may benefit from behavioral sleep modification. Pharmacologic treatment may be considered on a case-by-case basis, with hypnotics, anxiolytics, or sedating antidepressants used to manage insomnia, tailoring treatment to the symptom pattern. 5. Individuals with chronic headache are at increased risk for psychiatric disorders. Assessment for depression and anxiety may be warranted when either insomnia or hypersomnia is present. Psychiatric symptoms affect the choice of sedating versus alerting versus neutral pharmacologic agents for headache. 6. All headache patients, particularly those with episodic migraine and tension-type headaches, may benefit from inclusion of sleep variables in trigger management.

Clinical features of headache patients with fibromyalgia comorbidity

“…There are also evidences that rapid eye movement (REM) sleep deprivation is especially linked to hyperalgesia [45]. A significant association between severe sleep disturbances and chronic headache [46, 47] and central sensitization [48] has further been reported. Poor quality of sleep promotes diffusion of myofascial pain in headache patients, but which sleep phase is more involved in the generation of widespread pain remains to be clarified.…”

Polysomnographic characteristics in nonmalignant chronic pain populations: A review of controlled studies

“…A review of population-based longitudinal and cross-sectional studies showed that these types of headache are significantly related to insomnia symptoms, especially when frequent or severe, and some studies have also demonstrated bidirectional causality [74]. Virtually all sleep disorders, particularly OSA, are more prevalent among headache patients compared to HC, and dysregulation of sleep is a frequent trigger of migraine and TTH [75]. …”

Prevalence, clinical features and potential therapies for fibromyalgia in primary headaches

“…Clinical and preclinical data concur that sleep disruption causes hyperalgesia, and despite the widely distributed and overlapping neural networks that regulate states of sleep and pain, the brain mechanisms through which sleep and pain interact remain poorly understood [40,41]. A significant association of severe sleep disturbances and chronic headache [42,43] with central sensitization [44] has also been reported. Poor quality of sleep promotes diffusion of myofascial pain in headache patients, but which sleep phase is more involved in the generation of widespread pain remains to be clarified.…”