Sleep Disorders and Migraine: Review of Literature and Potential Pathophysiology Mechanisms

Vgontzas, Angeliki; Pavlović, Jelena

doi:10.1111/head.13358

Cited by 150 publications

(153 citation statements)

References 78 publications

(137 reference statements)

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“…Across 12 studies, prevalence of headache varied greatly from 18 to 60% of apneics. 14 In the US, the case-control study found daily snoring was two-fold more common among individuals with chronic daily headache than episodic headache. 19 Nevertheless, considerable evidence does indicate that snoring should be considered.…”

Section: Evaluation and Treatmentmentioning

confidence: 99%

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Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders

Rains

2018

Headache

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The relationship of sleep and migraine is unequivocal and familiarity with the nature and magnitude of these associations may inform clinical practice. Recent prospective, longitudinal, and time-series analysis has begun to unravel the magnitude and temporal patterns of sleep and migraine. Prospective evidence has shown that sleep variables can trigger acute migraine, precede and predict new onset headache by several years, and indeed, sleep disturbance and snoring are risk factors for chronification. The presence of a sleep disorder is associated with more frequent and severe migraine and portends a poorer headache prognosis. Interestingly, the disorders linked to migraine are quite varied, including insomnia, snoring and obstructive sleep apnea, restless legs, circadian rhythm disorders, narcolepsy, and others. Insomnia is by far the most common sleep disorder in headache patients. In fact, the majority of patients with chronic migraine presenting for treatment have insomnia. Despite a rapidly expanding literature, very few controlled treatment studies have been published to guide clinical practice. This paper focuses on clinical assessment and treatment of sleep disorders. An algorithm is presented for sleep disorders management in the migraine patient, which highlights major sleep disorders and psychiatric comorbidity. Diagnostic procedures are recommended that are conducive to clinical practice. Suggested tools include the sleep history, screening mnemonics, prediction equation, and sleep diary. New developments in treatment have produced abbreviated and cost-effective therapies for insomnia and obstructive sleep apnea that may reach a larger population. Revisions in the diagnostic manuals for sleep and headache disorders enhance recognition of sleep-related headache. Recommendations include behavioral sleep regulation, shown in recent controlled trials to decrease migraine frequency, management for sleep apnea headache, cognitive behavioral therapy (CBT) for insomnia abbreviated for the physician practice setting, sleep-related headache trigger, and others. There is no empirical evidence that sleep evaluation should delay or supersede usual headache care. Rather, sleep management is complimentary to standard headache practice.

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Section: Evaluation and Treatmentmentioning

confidence: 99%

“…A detailed review of sleep disorders related to migraine is presented elsewhere in this issue, 14 integrating new insights and latest neuroscience related to the glymphatic system to explain potential pathophysiological mechanisms underlying sleep disorders and migraine. Glymphatic activity is enhanced during sleep.…”

Section: Introductionmentioning

confidence: 99%

Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders

Rains

2018

Headache

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“…A recent study reported that patients with insomnia had a higher prevalence of migraine than did patients without insomnia; interestingly, patients with migraine who had insomnia reported more headache-related disability (as measured by the Headache Impact Test [HIT-6]) than patients with migraine but without insomnia. 17 A recent review of sleep disorders and migraine 18 provides an excellent overview of research into the relationship between the 2. [13][14][15] The relationship may be bi-directional, however.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Shift Work on Migraine: A Case Series and Narrative Review

et al. 2019

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Objective We present a case report of 2 migraine patients engaged in shift work, followed by a narrative review, to assess whether shift work influences headache‐related disability and chronification of migraine. Background Numerous modifiable factors can lead to chronification of migraine and to higher headache‐related disability. These include, among others, obesity, depression, overuse of acute medications, ineffective acute treatments, and stressful life events. Sleep disruptions and disorders are also felt to increase the risk of transitioning from episodic to chronic migraine. We hypothesize that shift work, which by definition leads to atypical or irregular sleep cycles, along with poor quality sleep, is a risk factor for chronification of migraine. Methods We present the case histories of 2 shift workers with migraine as per International Classification of Headache Disorders 3 criteria, seen at a large, busy academic headache center, followed by a narrative review of the literature. Results Previous literature regarding the relationship between shift work and migraine is sparse and conflicting, with more recent studies suggesting that shift work may be a risk factor for migraine‐related disability. In our case series, both patients initially reported severe migraine headache‐related disability and both patients had noted a worsening of their headaches after beginning night shift work. Both improved when switched back to day shifts, then worsened upon being put back on night shifts. Their headache patterns finally reverted from chronic to episodic migraine after eliminating night shifts completely and maintaining a good sleep routine. Conclusions In the 2 cases presented, shift work appeared to be associated with chronification of migraine and higher headache‐related disability despite optimal headache management and good patient adherence. A switch to only day shifts promoted transition to an episodic, less disabling pattern of migraine. It is clinically important to take a detailed sleep history in headache patients, and when appropriate, provide support for workplace accommodations. Further larger‐scale, rigorous studies are needed to more clearly delineate the relationship between shift work and migraine.

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“…For many individuals with migraine, the chronic nature of the disease significantly diminishes their quality of life and is isolating . In addition, depression, anxiety, and sleep disturbances are common comorbidities …”

Section: Introductionmentioning

confidence: 99%