Does Migraine Cause Poor Sleep or Vice Versa?

Patients with migraine experience greater sleep disturbance than those without the disorder, although it remains unclear whether migraines cause poor sleep or vice versa.

Results of a large meta-analysis showed both adults and children with migraines get less nightly REM sleep. In addition, the findings also show children get less total sleep time than peers without these debilitating headaches.

The relationship between sleep and migraine is complex, as sleep disturbances can be a trigger, treatment, or symptom of migraine.

“Our analysis provides a clearer understanding of migraines and how they affect sleep patterns and illustrates the impact that these patterns might have on a person’s ability to get a good night’s sleep,” Jan Hoffmann, MD, PhD, of King’s College London in the United Kingdom, said in a news release.

The study was published online September 22 in Neurology.

Subjective, Objective Sleep Affected

The meta-analysis included 32 studies with more than 10,000 adults and children with and without migraine. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and objective sleep architecture measured using polysomnography.

Overall, adults with migraines had higher (worse) scores than healthy adults on the PSQI (P < .001).

“This finding is not surprising; poor sleep is reported as an exacerbating factor for migraines in 50% of cases and the effect size was larger in chronic [migraine] patients, in line with previous research wherein poor sleep is shown to be an important factor in progression to chronic migraine,” the investigators note.

Polysomnography studies revealed that adults and children with migraine had a lower percentage of REM sleep (P = .017 and P = .025, respectively), than healthy controls.

Children with migraines also had less total nightly sleep time (P = .039) and more wake time (P < .001) but took less time to fall asleep (P < .001) than healthy peers.

The authors note that the analysis is unable to prove a causal relationship between sleep and migraines. In addition, the studies included in the analysis also did not report whether patients experienced migraine attacks during sleep itself and it was unclear whether patients were taking medications that affect sleep cycles.

Despite these caveats, they suggest the need for clinicians to “prioritize sleep interventions” in patients with migraine headaches.

Chicken or the Egg Scenario

Reached for comment, Bradley V. Vaughn, MD, a neurologist and professor of sleep medicine and epilepsy at the University of North Carolina, Chapel Hill, said, “This is an extension of other work that has shown both subjective and objective sleep issues seen in patients with migraine.”

“What I think we are still trying to understand is, if the sleep dysfunction is a nonspecific marker from the migraine or does the sleep dysfunction offer an avenue of treatment? As sleep is a function of the brain, we know many neurological conditions improve as we improve our sleep,” said Vaughn, who was not involved in the study.

Also weighing in on the analysis for Medscape Medical News, Shaheen E. Lakhan, MD, PhD, a neurologist in Newton, Massachusetts, said, “Interestingly, sleep and pain are both needed for survival and quite interrelated. This meta-analysis supports this concept.”

“Migraine, as a chronic pain disorder, seems to follow the rules that the more pain one has, the greater the sleep disturbance — subjective and objective,” Lakhan said.

“The relationship works both ways too in the classic ‘chicken or egg’ conundrum. Disturbances in sleep may precede chronic pain or are generated or worsened by pain. This phenomenon is mediated largely by changes to the neuroendocrine and inflammatory systems,” he explained.

“What is becoming clearer every year [is this]: Forget the ‘apple a day [keeps the doctor away].’ Whether you have migraines or not, a good night’s rest is exactly what the doctor ordered,” Lakhan said.

The study was supported by the Medical Research Council and the Migraine Trust in the UK. Hoffmann, Vaughn, and Lakhan have disclosed no relevant financial relationships.

Neurology. Published online September 22, 2021. Abstract

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