Research Finds Migraine Chronification, Sleep Problems Amplify Each Other

Sleep disorders are common among patients who struggle with migraines, and new research has found that the association between migraine chronification and sleep quality is bidirectional.

Chronic migraine is defined as a headache emerging 15 days or more per month for more than 3 months. The condition can be debilitating, leading to work disability, loss of workforce, and deteriorating quality of life. Global studies suggest that between 1.4% and 2.2% of the world population is diagnosed with chronic migraine.

There is a relationship between migraine and sleep, although its pathogenesis has not been fully understood. Insomnia can trigger migraine attacks, and sleep is disrupted during attacks.

An increasing amount of evidence also suggests that there may be a common underlying etiology between sleep disorders and migraine. Sleep deprivation results in decreased pain inhibition and dysfunction of the pathway, which in turn leads to the development of central sensitization and pain amplification.

In order to better understand these links, investigators conducted a comprehensive review of all published articles on chronic migraine and sleep quality from inception to March 2022 in the literature. A PubMed search for randomized controlled trials and open studies on chronic migraine and sleep quality reported in English between 1983 and 2022 was conducted and clinical trials, observational studies, and case series were included.

A total of 535 potentially relevant articles were found and 455 were excluded. In the remaining articles, 36 clinical studies reviewing sleep quality and its association with migraine were identified and reviewed.

They found that previous studies have evaluated a wide spectrum of sleep disorders commonly seen in patients with migraines, but chronic migraine is highly accompanied by insomnia, poorer sleep, sleep disturbances, and sleep insufficiency. Problems such as sleep deprivation, excessive sleeping, or inability to sleep regularly may be an important factor in the transition from episodic to chronic migraines.

Sleep disturbance, increased headache frequency, analgesic overuse, and depression are the strongest risk factors for the new onset of chronic migraine. In one study investigating the predictors of sleep quality, investigators found that depressive symptoms, pain, and headache-related disability had a 33% role in affecting sleep quality.

Many studies noted that insomnia triggers migraine, but research has also found that migraine is a precursor to insomnia. Fragmented sleep caused by chronic migraines can lower the pain threshold, as well as increase the risk of migraine attacks. As a result, migraine and sleep disorders have been hypothesized to have a potentially similar pathogenetic role.

Links between sleep disorders and migraine can also complicate treatments. Current migraine treatments either reduce pain or prevent the occurrence of migraine.

If there is accompanying insomnia, hypnotics and cognitive behavioral treatments may be beneficial. Patients with migraine and accompanying anxiety or depression may benefit from migraine prophylaxis with sedative antidepressants or anticonvulsants, whereas hypersomnia requires neutral or more stimulant drugs.

The authors noted that there are a limited number of studies utilizing polysomnographic and biochemical methods and there are fewer studies investigating the effects of pure chronic migraine on sleep. Instead, existing studies are more focused on treating chronic headaches or on the episodic group of patients.

As a disease, chronic migraine disrupts sleep quality with many triggering factors. It provokes the pain process again in disturbed sleep, and the authors concluded that if this interaction chain is not broken, the pathophysiology can continue in 2 directions. Further studies on sleep in migraine should be undertaken because there is no consensus on whether patients show objective changes in sleep architecture.

REFERENCE

Sacmaci H, Tanik N, Inan LE. Current Perspectives on the Impact of Chronic Migraine on Sleep Quality: A Literature Review. Nat Sci Sleep. 2022;14:1783-1800. https://doi.org/10.2147/NSS.S335949