Skip to main content

Cluster headaches and sleep disorders

Current Pain and Headache Reports volume 7, pages 150–156 (2003)Cite this article

Abstract

Cluster headaches are characterized by unilateral paroxysmal attacks of severe pain with associated symptoms. The headaches occur during particular sleep stages and are associated with other chronobiologic factors. Several sleep disorders have been associated with the occurrence of cluster headache; multiple hormonal influences affect the relationship between sleep and headache. Melatonin and other treatments that affect circadian rhythm have been suggested for the treatment of cluster headache. Obstructive sleep apnea can occur in patients with cluster headache; attempts to treat one disorder may influence the other. Sleep disorders such as insomnia and narcolepsy also may be associated with and influence cluster headaches. This article examines the relationship between the various sleep disorders and cluster headache, and reviews current research. Normal and abnormal sleep and details of treatments for specific sleep disorders that may decrease the frequency and severity of cluster headaches also are discussed. The relationship between obstructive sleep apnea, which is the most common sleep disorder, and cluster headache is discussed in detail.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References and Recommended Reading

  1. Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. Cephalagia 1988, 8(suppl 7):1–96.

    Google Scholar 

  2. Graham J: Cluster headache: the relation to arousal, relaxation, and autonomic tone. Headache 1990, 30:145–151.

    PubMed  Article  CAS  Google Scholar 

  3. Bono G, Micieli G, Manzoni GC, et al.: Chronobiological basis for the management of periodic headache. In Migraine, Clinical Research, and Advances. Edited by Clifford Rose F. Basel: Karger; 1985:206–217.

    Google Scholar 

  4. Dexter JD, Weitzman E: The relationship of nocturnal headaches to sleep stage patterns. Neurology 1970, 20:513.

    PubMed  CAS  Google Scholar 

  5. Russell D: Cluster headache: severity and temporal profiles of attacks and patient activity prior to and during attacks. Cephalalgia 1981, 1:209–216.

    PubMed  Article  CAS  Google Scholar 

  6. Kudrow L: Cluster headache: new concepts. Neurol Clin 1983, 1:369–383.

    Google Scholar 

  7. Dalessio DJ: Wolff’s Headache and Other Head Pain. New York: Oxford University Press; 1987.

    Google Scholar 

  8. Connors MJ: Cluster headache: a review. J Am Osteopath Assoc 1995, 95(9):533–9.

    PubMed  CAS  Google Scholar 

  9. Raimondi E: Premonitory symptoms in cluster headache. Curr Pain Headache Rep 2001, 5:55–59.

    PubMed  CAS  Google Scholar 

  10. Martelletti P, Giacovazzo M: Putative neuroimmunological mechanisms in cluster headache: an integrated hypothesis. Headache 1996, 36:312–315.

    PubMed  Article  CAS  Google Scholar 

  11. May A, Bahra A, Buchel C, et al.: Hypothalamic activation in cluster headache attacks. Lancet 1998, 352:275–278.

    PubMed  Article  CAS  Google Scholar 

  12. Russell D, von der Lippe A: Cluster headache: heart rate and blood pressure changes during spontaneous attacks. Cephalalgia 1982, 2:61–70.

    PubMed  Article  CAS  Google Scholar 

  13. Ferrari E, Canepari C, Bossolo PA, et al.: Changes of biological rhythms in primary headache syndromes. Cephalalgia 1983, 1(suppl):58–68.

    Google Scholar 

  14. Pfaffenrath V, Pollmann W, Ruther E, et al.: Onset of nocturnal attacks of chronic cluster headache in relation to sleep stages. Acta Neurol Scand 1986, 73:403–407.

    PubMed  CAS  Article  Google Scholar 

  15. Kudrow L: A possible role of the carotid body in the pathogenesis of cluster headache. Cephalalgia 1983, 33:241–247.

    Article  Google Scholar 

  16. Gallagher RM: Drug Therapy for Headache. New York: Marcel Dekker, Inc; 1991.

    Google Scholar 

  17. Kudrow L: The pathogenesis of cluster headache. Curr Opin Neurol 1994, 7:278–282.

    PubMed  CAS  Google Scholar 

  18. Polleri A, Nappi G, Murialdo G, et al.: Changes in the 24-hour prolactin pattern in cluster headache. Cephalalgia 1982, 2:1–7.

    PubMed  Article  CAS  Google Scholar 

  19. Kudrow L: Plasma testosterone and LH levels in cluster headache. Headache 1977, 17:91.

    Article  Google Scholar 

  20. Chazot G, Claustrat B, Brun J, et al.: A chronobiological study of melatonin, cortisol growth hormone, and prolactin secretion in cluster headache. Cephalalgia 1984, 4:213–220.

    PubMed  Article  CAS  Google Scholar 

  21. Leone M, Lucini V, D’Amico D, et al.: Twenty-four-hour melatonin and cortisol plasma levels in relation to timing of cluster headache. Cephalalgia 1995, 15:224–229.

    PubMed  Article  CAS  Google Scholar 

  22. Leone M, D’Amico D, Moschiano F, et al.: Melatonin versus placebo in the prophylaxis of cluster headache: a doubleblind pilot study with parallel groups. Cephalalgia 1996, 16:494–496.

    PubMed  Article  CAS  Google Scholar 

  23. Leone M, D’Amico D, Moschiano F, et al.: A double-blind pilot study on the efficacy of oral melatonin in cluster headache prophylaxis. Eur J Neurol 1996, 3(suppl 5):87.

    Google Scholar 

  24. Peres MF, Rozen TD: Melatonin in the preventive treatment of chronic cluster headache. Cephalalgia 2001, 21:993–995. The first study demonstrating that patients with chronic cluster headache who experience daytime and nocturnal attacks can receive benefit in alleviation of their cluster attacks with melatonin.

    PubMed  Article  CAS  Google Scholar 

  25. Alberca R, Botebol G, Boza F, Navarro A: Episodic cluster headache and narcolepsy: a case report. Cephalalgia 1991, 11:113–115.

    PubMed  Article  CAS  Google Scholar 

  26. Sahota PK, Dexter JD: Transient recurrent situational insomnia associated with cluster headache. Sleep 1993, 16:255–257.

    PubMed  CAS  Google Scholar 

  27. Mathew NT: Sleep apnea and other sleep abnormalities in primary headache disorders. 5th International Migraine Symposium, London, 1984.

  28. Chervin RD, Zallek SN, Lin X, et al.: Sleep disordered breathing in patients with cluster headache. Neurology 2000, 54:2302–2306. A key paper in which the authors perform polysomnography in patients with cluster headaches, demonstrating that sleep-disordered breathing, including sleep apnea, occurred in most of them. This suggests that, for patients with cluster headache, polysomnography should be performed to demonstrate the presence of obstructive sleep apnea.

    PubMed  CAS  Google Scholar 

  29. Young T, Evans L, Finn L, Palta M: Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middleaged men and women. Sleep 1997, 20:705–706.

    PubMed  CAS  Google Scholar 

  30. Kudrow L, McGinty DJ, Phillips ER, Stevenson M: Sleep apnea in cluster headache. Cephalalgia 1984, 4:33–38.

    PubMed  Article  CAS  Google Scholar 

  31. Shen JM, Schaanning J, White L, et al.: Cluster headache: the ventilatory response to transient hypoxia with pure nitrogen. Headache 1993, 33:476–482.

    PubMed  Article  CAS  Google Scholar 

  32. Chervin RD, Zallek SN, Lin X, et al.: Timing patterns of cluster headaches and association with symptoms of obstructive sleep apnea. Sleep Res Online 2000, 3:107–112. This study demonstrated an association between cluster headaches and obstructive sleep apnea symptoms typically occurring in the first half of the night, but not necessarily with sleep-related headaches. This key paper suggested that the physiologic consequences of sleep apnea may trigger cluster headaches during the early hours of sleep, thereby influencing the occurrence of subsequent daytime attacks. This confirmed earlier reports that cluster headaches almost always occur during nocturnal sleep periods. It also confirmed that obstructive sleep apnea can influence the course of cluster headaches.

    PubMed  CAS  Google Scholar 

  33. Paiva T, Farinha A, Martins A, et al.: Chronic headaches and sleep disorders. Arch Intern Med 1997, 157:1701–1705.

    PubMed  Article  CAS  Google Scholar 

  34. Buckle P, Kerr P, Kryger M: Nocturnal cluster headache associated with sleep apnea: a case report. Sleep 1993, 16:487–489.

    PubMed  CAS  Google Scholar 

  35. Nath Zallek S, Chervin RD: Improvement in cluster headache after treatment for obstructive sleep apnea. Sleep Med 2000, 1:135–138. An important study demonstrating marked improvement in cluster headaches in a patient when his obstructive sleep apnea was diagnosed and treated. The observations reported in this paper suggest that obstructive sleep apnea may trigger cluster headache attacks during certain periods.

    PubMed  Article  Google Scholar 

  36. Ludemann P, Frese A, Happe S, Evers S: Sleep disordered breathing in patients with cluster headache. Neurology 2001, 56:984.

    PubMed  CAS  Google Scholar 

  37. Krieger J: Breathing during sleep in normal subjects. In Principles and Practice of Sleep Medicine, edn 2. Edited by Kryger MH, Roth T, Dement WC. Philadelphia: WB Saunders; 1994:212–223.

    Google Scholar 

  38. Kudrow L: Cluster headache: a review. Clin J Pain 1989, 5:29–38.

    PubMed  CAS  Article  Google Scholar 

  39. Kudrow L: Response of cluster headache attacks to oxygen inhalation. Headache 1981, 21:1–4.

    PubMed  Article  CAS  Google Scholar 

  40. Costa A, Leston JA, Cavallini A, Nappi G: Cluster headache and periodic affective illness: common chronobiological features. Funct Neurol (Italy) 1998, 13:263–272. An excellent review discussing periodic conditions, such as cluster headache, seasonal affective disorder, and other mood disorders, and the connection with environmental events. Chronobiology and endocrinology and the associations with these illnesses are discussed in a good general review article.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Michigan Head Pain and Neurological Institute, 3120 Professional Drive, 48104, Ann Arbor, MI, USA

    James R. Weintraub DO

Authors
  1. James R. Weintraub DO
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Weintraub, J.R. Cluster headaches and sleep disorders. Current Science Inc 7, 150–156 (2003). https://doi.org/10.1007/s11916-003-0026-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-003-0026-0

Keywords

  • Melatonin
  • Obstructive Sleep Apnea
  • Sleep Apnea
  • Cluster Head
  • Sleep Disorder