Current Pain and Headache Reports

, Volume 6, Issue 6, pp 498–504 | Cite as

Chronic headache and sleep disturbance

  • Jeanetta C. Rains
  • Donald B. Penzien


Headache and sleep disturbance are common health complaints. Both complaints often co-exist in the same patient, leading some to suspect a causal relationship or common underlying pathology. However, the empirical literature in this area is limited. Some attempts have been made to explore the relationship between headache and sleep disturbance, but few consistencies have emerged in the literature. There is no accepted model for understanding the link between headache and sleep disturbance. This paper reviews the available literature concerning comorbid headache and sleep disturbance and offers some preliminary suggestions based on the available literature to guide their evaluation and management. Information specific to the relationship between sleep disturbance and chronic daily headache, where available, is highlighted.


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References and Recommended Reading

  1. 1.
    Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for the headache disorders, cranial neuralgias, and facial pain. Cephalalgia 1988, 8(suppl 7):1–96.Google Scholar
  2. 2.
    American Sleep Disorders Association, Diagnostic Classification Steering Committee: The International Classification of Sleep Disorders-Revised: Diagnostic and Coding Manual. Rochester: Davies; 1997.Google Scholar
  3. 3.
    Paiva T, Farinha A, Martins A, et al.: Chronic headaches and sleep disorders. Arch Intern Med 1997, 157:1701–1705.PubMedCrossRefGoogle Scholar
  4. 4.
    Ries PW: Current Estimates from the National Health Interview Survey-1984. United States: National Center for Health Statistics; 1986. [DHHS publication no. (PHS) 86-1584, Vital Health Stat, series 10, no. 156.]Google Scholar
  5. 5.
    Scher AI, Stewart WF, Liberman J: Prevalence of frequent headache in a population sample. Headache 1998, 38:497–506.PubMedCrossRefGoogle Scholar
  6. 6.
    Sanin LC, Mathew NT, Bellmeyer LR, Ali S: The International Headache Society (IHS) headache classification as applied to a headache clinic population. Cephalalgia 1994, 14:443–446.PubMedCrossRefGoogle Scholar
  7. 7.
    Jensen R: Pathophysiologic mechanisms of tension-type headache: a review of epidemiologic and experimental studies. Cephalalgia 1999, 19:602–621.PubMedCrossRefGoogle Scholar
  8. 8.
    Schwartz BS, Stewart WF, Simon D, Lipton RB: Epidemiology of tension-type headache. JAMA 1998, 27:381–383.CrossRefGoogle Scholar
  9. 9.
    Sheffield RE: Migraine prevalence: a literature review. Headache 1998, 38:595–601.PubMedCrossRefGoogle Scholar
  10. 10.
    Kudrow L: Cluster headache: a review. Clin J Pain 1989, 5:29–38.PubMedCrossRefGoogle Scholar
  11. 11.
    Kudrow L: Cluster Headache: Mechanisms and Management. London: Oxford University Press; 1980.Google Scholar
  12. 12.
    Newman LC, Goadsby PJ: Unusual primary headache disorders. In Wolff’s Headache and Other Head Pain, edn 7. Edited by Silberstein SD, Lipton RB, Dalession DJ. New York: Oxford Press; 2001:310–324.Google Scholar
  13. 13.
    Kayed K, Sjaastad O: Nocturnal and early morning headache. Ann Clin Res 1985, 17:243–246.PubMedGoogle Scholar
  14. 14.
    Paiva T, Esperanca P, Martins I, et al.: Sleep disorders in headache patients. Headache Quarterly 1992, 3(4):438–442.Google Scholar
  15. 15.
    Spierings ELH, van Hoof MJ: Fatigue and sleep in chronic headache sufferers: an age- and sex-controlled questionnaire study. Headache 1997, 37:549–552.PubMedCrossRefGoogle Scholar
  16. 16.
    Paiva T, Batista A, Martins P, Martins A: The relationship between headaches and sleep disturbance. Headache 1995, 35:590–596.PubMedCrossRefGoogle Scholar
  17. 17.
    Weissman MM, Greenwald S, Nino-Murcia G, Dement WC: The morbidity of insomnia uncomplicated by psychiatric disorders. Gen Hosp Psychiatry 1997, 19:245–250.PubMedCrossRefGoogle Scholar
  18. 18.
    Simon GE, VonKorff M: Prevalence, burden, and treatment of insomnia in primary care. Am J Psychiatry 1997, 154:1417–1423.PubMedGoogle Scholar
  19. 19.
    Partinen M, Hublin C: Epidemiology of sleep disorders. In Principles and Practice of Sleep Medicine. Edited by Kryger MH, Roth T, Dement WC. New York: WB Saunders; 2000:558–579.Google Scholar
  20. 20.
    Redline S: Epidemiology of sleep-disordered breathing. Sem Respir Crit Care Med 1998, 19:113–122.Google Scholar
  21. 21.
    Redline S, Strohl KP: Recognition and consequences of obstructive sleep apnea hypopnea syndrome. Clin Chest Med 1998, 19:1–19.PubMedCrossRefGoogle Scholar
  22. 22.
    Gislason T, Almqvist M, Eriksson G, et al.: Prevalence of sleep apnea syndrome among Swedish men: an epidemiologic study. J Clin Epidemiol 1988, 41:571–576.PubMedCrossRefGoogle Scholar
  23. 23.
    Coleman RM, Bliwise DL, Sajben N: Epidemiology of periodic limb movements of sleep. In Sleep/Wake Disorders: Natural History, Epidemiology, and Long-term Evolution. Edited by Guilleminault C, Lugaresi E. New York: Raven Press; 1988:217–229.Google Scholar
  24. 24.
    Montplaisir J, Nicolas A, Godbout R, Walters A: Restless legs syndrome and periodic limb movement disorder. In Principles and Practice of Sleep Medicine, edn 3. Edited by Kryger MH, Roth T, Dement WC. New York: WB Saunders; 2000: 742–752.Google Scholar
  25. 25.
    Rains JC, Penzien DB: Sleep and chronic pain: challenges to the a-EEG sleep pattern as a pain specific sleep anomaly. J Psychosom ResPP 2002, in press.Google Scholar
  26. 26.
    Fry JM, Pressman MR, DiPhillipo AM: a-d and disorders of excessive somnolence. Sleep Res 1987, 16:333.Google Scholar
  27. 27.
    Aldrich MS, Chauncey JB: Are morning headaches part of the obstructive sleep apnea syndrome? Arch Intern Med 1990, 150:1265–1267.PubMedCrossRefGoogle Scholar
  28. 28.
    Loh NK, Dinner DS, Foldvary N, et al.: Do patients with obstructive sleep apnea wake up with headaches? Arch Intern Med 1999, 159:1765–1768. Although retrospective, this study presents probably the strongest evidence identifying and describing the relationship between morning headache and obstructive sleep apnea. Headache was characterized appropriately according to standard International Headache Society diagnostic criteria, and sleep and sleep-related breathing were assessed through full, multi-channel, nocturnal polysomnography. Morning headache was associated with obstructive sleep apnea and remitted with successful treatment of apnea.PubMedCrossRefGoogle Scholar
  29. 29.
    Rains JC, Penzien DB, Mohammad Y: Sleep and headache: morning headaches associated with sleep-disordered breathing. Cephalalgia 2001, 21:520.CrossRefGoogle Scholar
  30. 30.
    Jennum P, Hein HO, Suadicani P, Gyntelberg F: Headache and cognitive dysfunction in snorers: a cross-sectional study of 3323 men aged 54 to 74 years: the Copenhagen Male Study. Arch Neurol 1994, 51:937–942.PubMedGoogle Scholar
  31. 31.
    Ulfberg J, Carter N, Talback M, Edling C: Headache, snoring, and sleep apnea. J Neurol 1996, 243:621–625.PubMedCrossRefGoogle Scholar
  32. 32.
    Raskin NH: The hypnic headache syndrome. Headache 1988, 29:534–536.CrossRefGoogle Scholar
  33. 33.
    Newman LC, Lipton RB, Solomon S: The hypnic headache syndrome: a benign headache disorder of the elderly. Neurology 1990, 40:1904–1905.PubMedGoogle Scholar
  34. 34.
    Inamorato E, Minatti-Hannuch SN, Zukerman E: The role of sleep in migraine attacks. Arq Neuropsiquiatr 1993, 51(4):429–432.PubMedGoogle Scholar
  35. 35.
    Penzien DB, Rains JC, Andrew ME, et al.: Relationship of daily stress, sleep, and headache: a time series analysis. Cephalalgia 2001, 21:262–263.Google Scholar
  36. 36.
    Blau JN: Sleep deprivation headache. Cephalalgia 1990, 10:157–160.PubMedCrossRefGoogle Scholar
  37. 37.
    Hsu LK, Crisp AH, Kalucy RS, et al.: Early morning migraine: nocturnal plasma levels of catecholamines, tryptophan, glucose, and free fatty acids and sleep encephalographs. Lancet 1977, 1:447–451.PubMedCrossRefGoogle Scholar
  38. 38.
    Dexter JD: The relationship between stage III and IV and REM sleep and arousals with migraine. Headache 1979, 19:364–369.PubMedCrossRefGoogle Scholar
  39. 39.
    Moldofsky H: Clinical review: sleep and pain. Sleep Med Rev 2001, 5:387–398.CrossRefGoogle Scholar
  40. 40.
    Blau JN: Resolution of migraine attacks: sleep and the recovery phase. J Neurol Neurosurg Psych 1982, 45:223–226.CrossRefGoogle Scholar
  41. 41.
    Gray RN, McCrory DC, Eberlein K, et al.: Parenteral Drug Treatments for Acute migraine Headache: Technical Review 2.5-1999. Agency for Health Care Policy and Research (under contract no. 29009402025). [NTIS accession no. 127862, National Technical Information Services.] This meta-analysis is the most comprehensive and systematic review of the efficacy of medications for the acute treatment of migraine.Google Scholar
  42. 42.
    Drewes AM, Arendt-Nielsen L: Pain and sleep in medical diseases: interactions and treatment possibilities a review. Sleep Res Online 2001, 4:67–76.Google Scholar
  43. 43.
    Hindmarch I, Rigney U, Stanley N, et al.: A naturalistic investigation of the effects of day-long consumption of tea, coffee, and water on alertness, sleep onset, and sleep quality. Psychopharm 2000, 149:203–216.CrossRefGoogle Scholar
  44. 44.
    Hering-Hanit R, Yavetz A, Dagan Y: Effect of withdrawal of misused medication on sleep disturbances in migraine sufferers with chronic daily headache. Headache 2000, 40:809–812.PubMedCrossRefGoogle Scholar
  45. 45.
    Roon KI, Bakker D, van Poelgeest MI, et al.: The influence of ergotamine abuse on psychologic and cognitive functioning. Cephalalgia 2000, 20:462–469.PubMedCrossRefGoogle Scholar
  46. 46.
    Gray RN, Goslin RE, McCrory DC, et al.: Drug Treatments for the Prevention of Migraine Headache. Technical Review 2.3-1999. Agency for Health Care Policy and Research (under contract no. 29009402025). [NTIS accession no. 127953, the National Technical Information Services] This meta-analysis is the most comprehensive and systematic review of the efficacy of medications of the prophylactic treatment of migraine.Google Scholar
  47. 47.
    Silberstein SD: Practice parameter: evidence-based guideline for migraine headache (an evidence-based review). Neurology 2000, 55:754–763.PubMedGoogle Scholar
  48. 48.
    Schweitzer PK: Drugs that disturb sleep and wakefulness. In Principles and Practice of Sleep Medicine, edn 3. Edited by Kryger MH, Roth T, Dement WC. Philadelphia: Harcourt; 2000: 441–461. This is the most comprehensive single source available that describes the effects of various commonly used medications on sleep.Google Scholar
  49. 49.
    Vogel G, Cohen J, Mullis D, et al.: Nefazodone and REM sleep: how do antidepressant drugs decrease REM sleep? Sleep 1998, 21:70–77.Google Scholar
  50. 50.
    Saper JR, Lake AE, Tepper SJ: Nefazodone for chronic daily headache prophylaxis: an open-label study. Headache 2001, 41:465–574.PubMedCrossRefGoogle Scholar
  51. 51.
    Sahota PK, Dexter JD: Sleep and headache syndromes: a clinical review. Headache 1990, 30:80–84.PubMedCrossRefGoogle Scholar
  52. 52.
    Biondi DM: Headaches and their relationship to sleep. Dent Clin North Am 2001, 45:685–700. The author provides a good review of various headache diagnoses that have been associated with sleep.PubMedGoogle Scholar
  53. 53.
    Harding SM: Complications and consequences of obstructive sleep apnea. Curr Opin Pulm Med 2000, 6:485–489.PubMedCrossRefGoogle Scholar
  54. 54.
    Kirsch DB, Jozefowicz RF: Neurologic complications of respiratory disease. Neurol Clin 2002, 20:247–264.PubMedCrossRefGoogle Scholar
  55. 55.
    Guilleminault C, Eldridge FL, Tilklan A, et al.: Sleep apnea syndrome due to upper airway obstruction: a review of 25 cases. Arch Intern Med 1977, 137:296–300.PubMedCrossRefGoogle Scholar
  56. 56.
    Guilleminault C, Dement WC: Sleep Apnea Syndromes. New York: Liss Press; 1978.Google Scholar
  57. 57.
    Biber MP: Nocturnal neck movements and sleep apnea in headache. Headache 1988, 28:673–674.PubMedCrossRefGoogle Scholar
  58. 58.
    Boutros NN: Headache in sleep apnea. Tex Med 1989, 85:34–35.PubMedGoogle Scholar
  59. 59.
    Kudrow L, McGinty DJ, Phillips ER, Stevenson M: Sleep apnea in cluster headache. Cephalalgia 1984, 4:33–38.PubMedCrossRefGoogle Scholar
  60. 60.
    Paiva T, Batista A, Martins P, Martins A: The relationship between headaches and sleep disturbances. Headache 1995, 35:590–596.PubMedCrossRefGoogle Scholar
  61. 61.
    Poceta JS, Dalessio DJ: Identification and treatment of sleep apnea in patients with chronic headache. Headache 1995, 35:586–589.PubMedCrossRefGoogle Scholar
  62. 62.
    Kiely JL, Murphy M, McNicholas WT: Subjective efficacy of nasal CPAP therapy in obstructive sleep apnea syndrome: a prospective controlled study. Eur Respir J 1999, 13:1086–1090.PubMedCrossRefGoogle Scholar
  63. 63.
    Poceta JS. Sleep-related headache. Curr Treat Options Neurol 2002, 4:121–128. This paper provides an overview of headaches associated with sleep, emphasizes treatment of primary sleep disorders, and offers general clinical recommendations for acute and prophylactic headache treatment.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Jeanetta C. Rains
    • 1
  • Donald B. Penzien
    • 1
  1. 1.Center for Sleep Evaluation, Elliot HospitalManchesterUSA

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