Neurological Sciences

, 29:169 | Cite as

Restless legs syndrome and primary headaches: a clinical study

  • Florindo d’Onofrio
  • Gennaro Bussone
  • Daniela Cologno
  • Vittorio Petretta
  • Maria Grazia Buzzi
  • Gioacchino Tedeschi
  • Vincenzo Bonavita
  • Giulio Cicarelli
Oral Communication

Abstract

Based on recent data about the association between restless legs syndrome (RLS) and migraine, we performed an observational study on the occurrence of RLS in patients affected by primary headaches. Two hundred headache patients (149 women and 51 men) and 120 (90 women and 30 men) sex-and age-matched control subjects were included. In the headache group, migraine without aura (MO) was the most represented headache type (n=114), followed by the “mixed” group (n=40) with MO, migraine with aura (MA) and frequent episodic tension-type headache (ETTH) in various combinations, and by ETTH alone (n=22). The remaining patients suffered from MA alone (n=10 MA), episodic cluster headache (ECH n=12) and primary stabbing headache (n=2). RLS frequency was significantly higher in headache patients than in control subjects (22.4% vs. 8.3, p=0.002) independently of sex, although with a female preponderance (84%) in both groups. More than 60% (n=27) of RLS patients were affected by MO and 30% (n=13) by a combination of two headache types (p≥0.001), with a very low frequency of RLS for the other types of headache. No RLS patient had ECH. No statistical differences were observed among clinical characteristics of different types of headache in groups with and without RLS. In both headache and control groups, higher scores for depression and anxiety were more frequent in subjects with RLS compared with those without RLS. Furthermore, headache patients with RLS reported sleep disturbances more frequently compared to those without RLS (50.0% vs. 32.7%; p<0.0001) and showed a normal or underweight body mass index. Our data seem to confirm the existence of an association between RLS and primary headaches, particularly with migraine, as already demonstrated. The absence of RLS in ECH patients is very interesting. Many pathogenetic considerations about links between RLS and primary headaches could be given, the most fitting involving dopamine and melatonin.

Keywords

Primary headache Restless legs syndrome Prevalence Clinical population Migraine 

References

  1. 1.
    Biary N, Koller W, Langenberg P (1990) Correlation between essential tremor and migraine headache. J Neurol Neurosurg Psychiatry 53:1060–1062PubMedCrossRefGoogle Scholar
  2. 2.
    Kwak C, Vuong KD, Jankovic J (2003) Migraine headache in patients with Tourette syndrome. Arch Neurol 60:1595–1598PubMedCrossRefGoogle Scholar
  3. 3.
    Teixera AL Jr, Meira FC, Maia DP et al (2004) Migraine headache in patients with Sydenham’s chorea. Cephalalgia 25:542–544CrossRefGoogle Scholar
  4. 4.
    Barbanti P, Fabbrini G (2002) Migraine and the extrapyramidal system. Cephalalgia 22:2–11PubMedCrossRefGoogle Scholar
  5. 5.
    Rains JC, Poceta JS (2006) Headache and sleep disorders: review and clinical implications for headache management. Headache 46:1344–1363PubMedGoogle Scholar
  6. 6.
    Rhode AM, Hösing VG, Happe S et al (2007) Comorbidity of migraine and restless legs syndrome — a case-control study. Cephalalgia 27:1255–1260PubMedCrossRefGoogle Scholar
  7. 7.
    Ekbom KA (1945) Restless legs. A clinical study. Acta Med Scand 158[Suppl]:1–123Google Scholar
  8. 8.
    Walters AS, for the International Restless Legs Syndrome Study Group (1995) Toward a better definition of restless legs syndrome. Mov Disord 10:634–642PubMedCrossRefGoogle Scholar
  9. 9.
    Allen RP, Hening WA, Montplaisir J et al (2003) Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology: a report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 4:101–119PubMedCrossRefGoogle Scholar
  10. 10.
    Phillips B, Young T, Finn L et al (2000) Epidemiology of restless legs symptoms in adults. Arch Intern Med 160:2137–2141PubMedCrossRefGoogle Scholar
  11. 11.
    Zucconi M, Ferini-Strambi L (2004) Epidemiology and clinical findings of restless legs syndrome. Sleep Med 5:293–299PubMedCrossRefGoogle Scholar
  12. 12.
    Headache Classification Subcommittee of the International Headache Society (2004) The International Classification of Headache Disorders. Cephalalgia 24[Suppl 1]:9–160Google Scholar
  13. 13.
    American Academy of Sleep Medicine (2005) International Classification of Sleep Disorders: Diagnostic and Coding Manual, 2nd Edn. American Academy of Sleep Medicine, Westchester, ILGoogle Scholar
  14. 14.
    Hamilton M (1960) A rating scale for anxiety. J Neurol Neurosurg Psychiatry 23:56–62PubMedGoogle Scholar
  15. 15.
    Beck AT, Steer RA, Garbin MG (1988) Psychometric properties of the Beck Depression Inventory. Twenty-five years of evaluation. Clin Psychol Rev 8:77–100CrossRefGoogle Scholar
  16. 16.
    Allen RP, Walters AS, Montplaisir J et al (2005) Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med 165:1286–1292PubMedCrossRefGoogle Scholar
  17. 17.
    Bjorvatn B, Leissner L, Ulfberg J et al (2005) Prevalence, severity and risk factors of restless legs syndrome in the general adult population in two Scandinavian countries. Sleep Med 6:307–312PubMedCrossRefGoogle Scholar
  18. 18.
    Sevim S, Dogu O, Kaleagasi H et al (2004) Correlation of anxiety and depression symptoms in patients with restless legs syndrome: a population based survey. J Neurol Neurosurg Psychiatry 75:226–230PubMedGoogle Scholar
  19. 19.
    Ulfberg J, Nystrom B, Carter N, Edling C (2001) Prevalence of restless legs syndrome among men aged 18 to 64 years: an association with somatic disease and neuropsychiatric symptoms. Mov Disord 16:1159–1163PubMedCrossRefGoogle Scholar
  20. 20.
    Torelli P, Beghi E, Manzoni GC (2005) Cluster headache prevalence in the Italian general population. Neurology 64:469–474PubMedGoogle Scholar
  21. 21.
    Entezari T, Singleton JR, Jones CR et al (1999) Changes in excitability of motor cortical circuitry in primary restless legs syndrome. Neurology 53:1201–1205Google Scholar
  22. 22.
    Brighina F, Piazza A, Daniele O, Fierro B (2002) Modulation of visual cortical excitability in migraine with aura: effects of 1 Hz repetitive transcranial magnetic stimulation. Exp Brain Res 145:177–181PubMedCrossRefGoogle Scholar
  23. 23.
    Allen R (2004) Dopamine and iron in the pathophysiology of restless legs syndrome (RLS). Sleep Med 5:385–391PubMedCrossRefGoogle Scholar
  24. 24.
    Wetter TC, Eisensehr I, Trenkwalder C (2004) Functional neuroimaging studies in restless legs syndrome. Sleep Med 5:401–406PubMedCrossRefGoogle Scholar
  25. 25.
    Fanciullacci M, Alessandri M, Del Rosso A (2000) Dopamine involvement in the migraine attack. Funct Neurol 15[Suppl 3]:171–181PubMedGoogle Scholar
  26. 26.
    Michaud M, Dumont M, Selmaoui B et al (2004) Circadian rhythm of restless legs syndrome: relationship with biological markers. Ann Neurol 55:372–380PubMedCrossRefGoogle Scholar
  27. 27.
    Waldenlind E, Gustafsson S, Ekbom K, Wetterberg L (1987) Circadian secretion of cortisol and melatonin in cluster headache during active cluster periods and remission. J Neurol Neurosurg Psychiatry 50:207–213PubMedGoogle Scholar
  28. 28.
    Leone M, Lucini V, D’Amico D et al (1995) Twenty-four-hour melatonin and cortisol plasma levels in relation to timing of cluster headache. Cephalalgia 15:224–229PubMedCrossRefGoogle Scholar
  29. 29.
    Ondo WG, He Y, Rajasekaran S, Le WD (2000) Clinical correlates of 6-hydroxydopamine injections into A11 dopaminergic neurons in rats: a possible model for restless legs syndrome. Mov Disord 15:154–158PubMedCrossRefGoogle Scholar
  30. 30.
    Welch KM, Nagesh V, Aurora SK, Gelman N (2001) Periaqueductal gray matter dysfunction in migraine: cause or the burden of illness? Headache 41:629–637PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Florindo d’Onofrio
    • 1
  • Gennaro Bussone
    • 2
  • Daniela Cologno
    • 3
  • Vittorio Petretta
    • 1
  • Maria Grazia Buzzi
    • 4
  • Gioacchino Tedeschi
    • 5
  • Vincenzo Bonavita
    • 6
  • Giulio Cicarelli
    • 1
  1. 1.Neurology Unit“S.G. Moscati” Hospital Viale ItaliaAvellinoItaly
  2. 2.Neurological Institute “C. Besta”MilanItaly
  3. 3.Clinical Neurophysiology Department of NeuroscienceOspedali “Riuniti”FoggiaItaly
  4. 4.IRCCS S. Lucia FoundationRomeItaly
  5. 5.Institute of Neurology2nd University of NaplesNaplesItaly
  6. 6.Department of Neurological Sciences“Federico II” UniversityNaplesItaly

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