Sleep in Patients with Chronic Migraine
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Purpose of Review
The biological and pathophysiological interaction between sleep and chronic migraine (CM) remains to be fully elucidated. In this article, we provide a narrative review of the literature on sleep disturbance and CM, highlighting recent advances in sleep research and insights into mechanisms that could mediate a role of sleep disturbances in migraine chronification. We discuss the potential for cognitive-behavioral insomnia therapy (CBTi) as an intervention for CM with comorbid insomnia. Finally, we propose a model of the mechanisms underlying the interactions among sleep physiology, maladaptive migraine-coping behaviors, and coexisting factors which contribute to sleep disturbances in CM based on conceptual models used in sleep research.
Insomnia is the most common sleep complaint among patients with CM. CM patients experience more frequent and severe insomnia symptoms than patients with episodic migraine (EM). It has been suggested that sleep disturbances may predispose individuals to migraine attacks, which may affect the pain-processing trigeminovascular system and thus play a role in migraine progression. Encouraging but limited evidence suggests that management of insomnia via behavioral sleep therapy may reverse CM to EM and possibly prevent migraine chronification.
Migraine has a complex relationship with sleep. The use of objective sleep study such as polysomnographic microstructural sleep analysis and actigraphy could help connect sleep disturbances and processes related to CM. Future longitudinal studies should examine whether effective behavioral treatments such as CBTi can reverse migraine chronification.
KeywordsChronic migraine Sleep disorders Chronic daily headache Insomnia
Rapid eye movement
CP-Y takes responsibility for the literature interpretation and manuscript writing. SJ-W has full access to all data in this study, has the right to publish any or all of the data, and takes responsibility for the final manuscript.
Compliance with Ethical Standards
This study was supported, in part, by grants from the Ministry of Science and Technology (MST; 100-2314-B-010-019-MY2, 100-2314-B-010-018-MY3), Taipei-Veterans General Hospital (V103C-080, VGHUST103-G7-4-1, V103E9-006), MST support for the Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taiwan (NSC 102-2911-I-008-001), Brain Research Center, National Yang-Ming University, and the Ministry of Education, Aim for the Top University Plan and the Ministry of Health and Welfare (MOHW104-TDU-B-211-113-003).
Conflict of Interest
Chun-Pai Yang declares no potential conflicts of interest.
Shuu-Jiun Wang has served on the advisory boards of Allergan and Eli Lilly. He has received speaking honoraria from local companies (Taiwan branches) of Pfizer, Elli Lilly, GSK, and MSD. He has received research grants from the Taiwan National Science Council, Taipei Veterans General Hospital, and Taiwan Headache Society.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.• Manack A, Turkel C, Silberstein S. The evolution of chronic migraine: classification and nomenclature. Headache. 2009;49:1206–13. This is a nice review article summarizing the evolution of chronic migraine nomenclature and criteria.Google Scholar