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Sleep in Patients with Chronic Migraine

Current Pain and Headache Reports volume 21, Article number: 39 (2017) Cite this article

Abstract

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.

Recent Findings

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.

Summary

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.

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Fig. 1

Abbreviations

CM:

Chronic migraine

EM:

Episodic migraine

EEG:

Electroencephalography

PSG:

Polysomnography

REM:

Rapid eye movement

SWS:

Slow-wave sleep

References

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.

  2. Olesen J. ICHD-3 beta is published. Use it immediately. Cephalalgia. 2013;33:627–8.

    Article  PubMed  Google Scholar 

  3. Bigal ME, Serrano D, Reed M, Lipton RB. Chronic migraine in the population: burden, diagnosis, and satisfaction with treatment. Neurology. 2008;71:559–66.

    Article  PubMed  Google Scholar 

  4. Ferrari A, Leone S, Vergoni AV, Bertolini A, Sances G, Coccia CP, et al. Similarities and differences between chronic migraine and episodic migraine. Headache. 2007;47:65–72.

    Article  PubMed  Google Scholar 

  5. •• Ong JC, Park M. Chronic headaches and insomnia: working toward a biobehavioral model. Cephalalgia. 2012;32:1059–70. This article is a good review of the evidence on insomnia and chronic headaches.

    Article  PubMed  Google Scholar 

  6. Kelman L, Rains JC. Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache. 2005;45:904–10.

    Article  PubMed  Google Scholar 

  7. Calhoun AH, Ford S, Finkel AG, Kahn KA, Mann JD. The prevalence and spectrum of sleep problems in women with transformed migraine. Headache. 2006;46:604–10.

    Article  PubMed  Google Scholar 

  8. Sancisi E, Cevoli S, Vignatelli L, Nicodemo M, Pierangeli G, Zanigni S, et al. Increased prevalence of sleep disorders in chronic headache: a case-control study. Headache. 2010;50:1464–72.

    Article  PubMed  Google Scholar 

  9. Lin YK, Lin GY, Lee JT, Lee MS, Tsai CK, Hsu YW, et al. Associations between sleep quality and migraine frequency: a cross-sectional case-control study. Medicine. 2016;95:e3554.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cho SJ, Chu MK. Risk factors of chronic daily headache or chronic migraine. Curr Pain Headache Rep. 2015;19:465.

    Article  PubMed  Google Scholar 

  11. Peres MF, Stiles MA, Siow HC, Silberstein SD. Excessive daytime sleepiness in migraine patients. J Neurol Neurosurg Psychiatry. 2005;76:1467–8.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. Calhoun AH, Ford S. Behavioral sleep modification may revert transformed migraine to episodic migraine. Headache. 2007;47:1178–83.

    Article  PubMed  Google Scholar 

  13. Smitherman TA, Walters AB, Davis RE, Ambrose CE, Roland M, Houle TT, et al. Randomized controlled pilot trial of behavioral insomnia treatment for chronic migraine with comorbid insomnia. Headache. 2016;56:276–91.

    Article  PubMed  Google Scholar 

  14. Cevoli S, Giannini G, Favoni V, Pierangeli G, Cortelli P. Migraine and sleep disorders. Neurol Sci. 2012;33(Suppl 1):S43–6.

    Article  PubMed  Google Scholar 

  15. Stark RJ, Ravishankar K, Siow HC, Lee KS, Pepperle R, Wang SJ. Chronic migraine and chronic daily headache in the Asia–Pacific region: a systematic review. Cephalalgia. 2013;33:266–83.

    Article  PubMed  Google Scholar 

  16. Lu SR, Fuh JL, Chen WT, Juang KD, Wang SJ. Chronic daily headache in Taipei, Taiwan: prevalence, follow-up and outcome predictors. Cephalalgia. 2001;21:980–6.

    CAS  Article  PubMed  Google Scholar 

  17. Chen PK, Fuh JL, Chen SP, Wang SJ. Association between restless legs syndrome and migraine. J Neurol Neurosurg Psychiatry. 2010;81:524–8.

    Article  PubMed  Google Scholar 

  18. Chen PK, Fuh JL, Wang SJ. Bidirectional triggering association between migraine and restless legs syndrome: a diary study. Cephalalgia. 2016;36:431–6.

    Article  PubMed  Google Scholar 

  19. Fuh JL, Chung MY, Yao SC, Chen PK, Liao YC, Hsu CL, et al. Susceptible genes of restless legs syndrome in migraine. Cephalalgia. 2016;36:1028–37.

    Article  Google Scholar 

  20. Houle TT, Butschek RA, Turner DP, Smitherman TA, Rains JC, Penzien DB. Stress and sleep duration predict headache severity in chronic headache sufferers. Pain. 2012;153:2432–40.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Vgontzas A, Cui L, Merikangas KR. Are sleep difficulties associated with migraine attributable to anxiety and depression? Headache. 2008;48:1451–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Stark CD, Stark RJ. Sleep and chronic daily headache. Curr Pain Headache Rep. 2015;19:468.

    Article  PubMed  Google Scholar 

  23. Barbanti P, Aurilia C, Egeo G, Fofi L, Vanacore N. A case-control study on excessive daytime sleepiness in chronic migraine. Sleep Med. 2013;14:278–81.

    Article  PubMed  Google Scholar 

  24. Vendrame M, Kaleyias J, Valencia I, Legido A, Kothare SV. Polysomnographic findings in children with headaches. Pediatr Neurol. 2008;39:6–11.

    Article  PubMed  Google Scholar 

  25. Drake ME Jr, Pakalnis A, Andrews JM, Bogner JE. Nocturnal sleep recording with cassette EEG in chronic headaches. Headache. 1990;30:600–3.

    Article  PubMed  Google Scholar 

  26. Lund N, Westergaard ML, Barloese M, Glumer C, Jensen RH. Epidemiology of concurrent headache and sleep problems in Denmark. Cephalalgia. 2014;34:833–45.

    Article  PubMed  Google Scholar 

  27. Roehrs T, Roth T. Sleep and pain: interaction of two vital functions. Semin Neurol. 2005;25:106–16.

    Article  PubMed  Google Scholar 

  28. Smith MT, Edwards RR, McCann UD, Haythornthwaite JA. The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep. 2007;30:494–505.

    Article  PubMed  Google Scholar 

  29. •• Holland PR. Headache and sleep: shared pathophysiological mechanisms. Cephalalgia. 2014;34:725–44. This is a nice review article describing the pathophysiology mechanisms between sleep and headache.

    Article  PubMed  Google Scholar 

  30. Evers S. Sleep and headache: the biological basis. Headache. 2010;50(7):1246–51.

    Article  PubMed  Google Scholar 

  31. Alberti A. Headache and sleep. Sleep Med Rev. 2006;10:431–7.

    Article  PubMed  Google Scholar 

  32. Brennan KC, Charles A. Sleep and headache. Semin Neurol. 2009;29:406–18.

    CAS  Article  PubMed  Google Scholar 

  33. Lovati C, D'Amico D, Raimondi E, Mariani C, Bertora P. Sleep and headache: a bidirectional relationship. Expert Rev Neurother. 2010;10:105–17.

    Article  PubMed  Google Scholar 

  34. Terzano MG, Parrino L, Sherieri A, Chervin R, Chokroverty S, Guilleminault C, et al. Atlas, rules, and recording techniques for the scoring of cyclic alternating pattern (CAP) in human sleep. Sleep Med. 2001;2:537–53.

    CAS  Article  PubMed  Google Scholar 

  35. Della Marca G, Vollono C, Rubino M, Di Trapani G, Mariotti P, Tonali PA. Dysfunction of arousal systems in sleep-related migraine without aura. Cephalalgia. 2006;26:857–64.

    CAS  PubMed  Google Scholar 

  36. Nayak C, Sinha S, Nagappa M, Nagaraj K, Kulkarni GB, Thennarasu K, et al. Study of sleep microstructure in patients of migraine without aura. Sleep Breath. 2016;20:263–9.

    CAS  Article  PubMed  Google Scholar 

  37. Bruni O, Russo PM, Violani C, Guidetti V. Sleep and migraine: an actigraphic study. Cephalalgia. 2004;24:134–9.

    CAS  Article  PubMed  Google Scholar 

  38. Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep. 2006;29:1415–9.

    Article  PubMed  Google Scholar 

  39. Edinger JD, Wohlgemuth WK, Krystal AD, Rice JR. Behavioral insomnia therapy for fibromyalgia patients: a randomized clinical trial. Arch Intern Med. 2005;165:2527–35.

    Article  PubMed  Google Scholar 

  40. Jungquist CR, O'Brien C, Matteson-Rusby S, Smith MT, Pigeon WR, Xia Y, et al. The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain. Sleep Med. 2010;11:302–9.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Johnson JA, Rash JA, Campbell TS, Savard J, Gehrman PR, Perlis M, et al. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Med Rev. 2016;27:20–8.

    Article  PubMed  Google Scholar 

  42. Dodick DW, Turkel CC, DeGryse RE, Aurora SK, Silberstein SD, Lipton RB, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010;50:921–36.

    Article  PubMed  Google Scholar 

  43. Mathew NT, Jaffri SF. A double-blind comparison of onabotulinumtoxinA (BOTOX) and topiramate (TOPAMAX) for the prophylactic treatment of chronic migraine: a pilot study. Headache. 2009;49:1466–78.

    Article  PubMed  Google Scholar 

  44. Silberstein SD, Lipton RB, Dodick DW, Freitag FG, Ramadan N, Mathew N, et al. Efficacy and safety of topiramate for the treatment of chronic migraine: a randomized, double-blind, placebo-controlled trial. Headache. 2007;47:170–80.

    Article  PubMed  Google Scholar 

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Author information

Affiliations

  1. Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan

    Chun-Pai Yang

  2. Department of Nutrition, Huang-Kuang University, Taichung, Taiwan

    Chun-Pai Yang

  3. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Shuu-Jiun Wang

  4. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, 11217

    Shuu-Jiun Wang

  5. Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan

    Shuu-Jiun Wang

Authors
  1. Chun-Pai Yang
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Contributions

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.

Corresponding author

Correspondence to Shuu-Jiun Wang.

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Funding

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.

Additional information

This article is part of the Topical Collection on Chronic Daily Headache

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Yang, CP., Wang, SJ. Sleep in Patients with Chronic Migraine. Curr Pain Headache Rep 21, 39 (2017). https://doi.org/10.1007/s11916-017-0641-9

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  • DOI: https://doi.org/10.1007/s11916-017-0641-9

Keywords

  • Chronic migraine
  • Sleep disorders
  • Chronic daily headache
  • Insomnia