Patients With Migraine More Likely to Suffer Poor Sleep Quality

Damian McNamara

June 29, 2018

SAN FRANCISCO  — Although average sleep duration and prevalence of short sleep duration, defined as sleeping less than 6 hours a day, do not significantly differ between migraineurs and individuals with nonmigraine headaches or those who do not experience headaches, sleep quality is a different story.

Investigators for the Korean Headache Sleep Study surveyed a nationally representative sample of 2695 people and found that the 5.3% who experience migraines were significantly more likely to report poor sleep quality, with Pittsburgh Sleep Quality Index (PSQI) scores greater than 5.

Although the mechanism remains unclear, cortical spreading depression, hyperexcitability, and changes in the thalamo-trigeminal tract and/or the orexin pathway may explain the association between sleep and migraine, study investigator Tae-Jin Song, MD, PhD, from the Department of Neurology at the Ewha Womans University College of Medicine in Seoul, South Korea, said here at the American Headache Society (AHS) Annual Meeting 2018.

Potential Mechanism

In addition to asking patients with migraine about sleep quality, Song recommended some proven interventions to reduce headache frequency and intensity in previous studies (Cephalgia. 2012;32:1059-1070).  

"Migraine patients might benefit from behavioral sleep modification," said Song. This includes limiting daytime naps to 30 minutes, exercising, ensuring exposure to natural light, and establishing a regular and relaxing bedtime routine.

In the current study, 10.3% of the overall 2695 survey respondents slept less than 6 hours in a 24-hour period. Among the migraineurs, this prevalence was 11.8%, a nonsignificant difference.

Migraineurs are known to experience more sleep disturbances, such as insomnia, excessive daytime sleepiness, and snoring/bruxism, and lower sleep quality may be the culprit, Song said.

An earlier report revealed that 37% of 12,810 participants in the Chronic Migraine Epidemiology and Outcomes (CaMEO) study were at risk for sleep apnea, a rate higher than the rate in the general population.  

In addition, other investigators reported that repetitive yawning could signal or accompany migraine attacks, suggesting an opportunity for early treatment, according to a cross-sectional study of 339 people with migraines.

Prevalence of poor sleep quality in the current study was higher in the migraine group, with 48% scoring greater than 5 on the PSQI compared with 31% of those with nonmigraine headache and 21% of the nonheadache group (P < .001).

Migraineurs who reported sleeping on average less than 6 hours per day were also more likely to experience increased headache frequency, Song reported. In a comparison of 68 migraineurs with short duration sleep and 75 migraineurs who slept longer, those who slept less than 6 hours experienced a mean of 2.0 headaches per month compared with 1.0 headache among those sleeping 6 hours or longer in 24 hours.

"Why is sleep associated with migraine? We cannot explain this with a definitive mechanism. But cortical spreading depression [may play a role]," said Song.

Cortical spreading depression can activate subcortical pathways. Also, during the deep sleep non–rapid eye movement phase, slow-wave thalamocortical oscillatory activity could alter sensory processing, he explained. In addition, increased activity of the orexin system in the brain could be triggered by stress, sleep deprivation, or poor sleep hygiene, making this pathway a key player in the association between sleep and migraine.

"I think the study is clinically helpful," session co-moderator Toshihiko Shimizu, MD, PhD, told Medscape Medical News. "If patients are getting short sleep and they have migraines, [addressing their sleep quality] could be an alternative way to improve their migraines without medication." Shimizu is chair of the Pain Asian Committee for the American Headache Society and is affiliated with the Department of Neurology at Keio University School of Medicine in Tokyo , Japan.

Song and Shimizu have disclosed no relevant financial relationships.

American Headache Society (AHS) Annual Meeting 2018. Presented June 28, 2018.

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