Sleep in Patients with Chronic Migraine

• Published in: Current pain and headache reports 2017-09, Vol.21 (9), p.39-39, Article 39
• Main Authors: Yang, Chun-Pai, Wang, Shuu-Jiun
• Format: Article
• Language: English
• Subjects: Chronic Daily Headache (SJ Wang; Chronic Pain - complications; Chronic Pain - physiopathology; Chronic Pain - therapy; Humans; Insomnia; Internal Medicine; Medicine; Medicine & Public Health; Migraine; Migraine Disorders - etiology; Pain Medicine; Section Editor; Sleep; Sleep Initiation and Maintenance Disorders - complications; Sleep Initiation and Maintenance Disorders - physiopathology; Sleep Initiation and Maintenance Disorders - therapy; Sleep Wake Disorders - complications; Sleep Wake Disorders - physiopathology; Sleep Wake Disorders - therapy; Topical Collection on Chronic Daily Headache
• ISSN: 1531-3433; 1534-3081
• DOI: 10.1007/s11916-017-0641-9

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.