Insomnia in patients with migraine

Abstract

Objective: to evaluate the significance of insomnia and chronobiological patterns in the development of headache (HA) attacks for the formation of clinical features of migraine and for the elaboration of strategies for its prevention.Patients and methods. A prospective comparative study was conducted in 60 patients aged 18–65 years who were diagnosed as having migraine (with or without aura) with comorbid sleep disorder. Group 1 consisted of 30 patients with migraine and insomnia; Group 2 comprised 30 patients with migraine without insomnia. The study participation included four visits to a physician for 12 months.Results and discussion. Persistent sleep disorders in patients with migraine were shown to worsen the course of the underlying disease: HA attacks had a greater intensity, mainly left-sided localization and a longer duration. Group 1 patients were observed to have a chronic course of the disease with a frequency of ≥8 attacks per month in 33% of cases. Analysis of biological rhythms revealed that individuals with evening and mildly evening chronotypes were characterized by the greatest changes in the sleep-wake cycle, by sleep deprivation and its reduced efficiency. Analysis of the data of HA and sleep diaries kept by the patients for 12 months showed that Group 1 had four peaks of the daily distribution of HA attacks; 13.4% of attacks occurred during sleep and early morning.Conclusion. The coexistence of sleep disorders and HA is not only manifested as the overlapping of clinical manifestation, but also largely determines their natural course and prognosis, i.e. their progression into a chronic form. Therefore, it is imperative to identify sleep disorders in migraines, since their correction is effective and, in most cases, allows chronic HA to progress to an episodic form.

Keywords

• migraine
• chronic migraine
• risk factors for chronic migraine
• insomnia
• sleep-wake cycle
• chronobiology
• biological rhythms
• melatonin