Morning headaches in patients with sleep disorders

Sleep quality evaluation, correlation with headache frequency, and propensity to conversion from episodic to chronic daily headache in migraine patients: A cross-sectional study

Objective

The aim of the study was to determine the association between sleep quality with headache frequency in migraine patients and also to evaluate migraine trigger and non-headache symptoms in episodic and chronic migraine groups and evaluation of the same in poor and good sleepers (GSs) in migraine population.

Materials and Methods

In a cross-sectional and observational study in a tertiary care hospital of East India between January 2018 and September 2020, migraine patients were evaluated. Migraine patients were divided into two groups: Episodic migraine (EM) and chronic migraine (CM) group according to ICHD 3 b classification and into poor sleepers (PSs, Global Pittsburgh Sleep Quality Index [PSQI] >5) and GSs (Global PSQI ≤5). Sleep was evaluated using PQSI - a self-rated questionnaire and disease pattern, associated non-headache symptoms, and triggers were evaluated in between groups. Demographic, headache character, and sleep parameters including seven "component" scores: Subjective sleep quality, sleep latency, sleeps duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction and global PQSI were compared between groups (EM and CM). Similar parameters were also compared between PSs and GSs group. Statistical analysis was performed using the χ2 test for categorical variables and the t-test and Wilcoxon rank-sum test for continuous variables. Correlation between two normally distributed numerical was tested by Pearson correlation coefficient assessment.

Results

One hundred migraine patients were analyzed, among which 57 were PSs and 43 were GSs and 51 patients had EM and 49 patients had CM. Moderately significant "r" value noted in between headache frequency and global PQSI score (r = 0.45, P < 0.01). In non-headache symptoms, blurring of vision (EM 8 [16%] and CM 16 [33%] P = 0.05), nasal congestion (EM - 3 [6%] and CM - 12 [24%], P = 0.01), and cervical muscle tenderness (EM- 23 [45%] and CM - 34 [69%], P = 0.01) were more prevalent in chronic headache group along with allodynia (EM - 11 [22%] and CM - 25 [51%], P < 0.01).

Conclusion

Chronic headache group had poor subjective sleep quality, increased sleep latency, decreased sleep duration, decreased sleep efficiency, and increased sleep disturbance in comparison to episodic group which has therapeutic implication. The non-headache symptoms which are more prevalent in CM patients increase the overall disability.

Metabolic Aspects of Migraine: Association With Obesity and Diabetes Mellitus

Migraine is a disabling neurovascular disorder, characterized by moderate to severe unilateral headaches, nausea, photophobia, and/or phonophobia, with a higher prevalence in women than in men, which can drastically affect the quality of life of migraine patients. In addition, this chronic disorder is related with metabolic comorbidities associated with the patient's lifestyle, including obesity and diabetes mellitus (DM). Beyond the personal and socioeconomic impact caused by migraine, obesity and DM, it has been suggested that these metabolic disorders seem to be related to migraine since: (i) they are a risk factor for developing cardiovascular disorders or chronic diseases; (ii) they can be influenced by genetic and environmental risk factors; and (iii) while clinical and epidemiological studies suggest that obesity is a risk factor for migraine, DM (i.e., type 1 and type 2 DM) have been reported to be either a protective or a risk factor in migraine. On this basis, and given the high worldwide prevalence of migraine, obesity, and DM, this article provides a narrative review of the current literature related to the association between the etiology and pathophysiology of migraine and these metabolic disorders, considering lifestyle aspects, as well as the possible involvement of neurotransmitters, neuropeptides, and/or sex hormones. While a link between migraine and metabolic disorders has been suggested, many studies are contradictory and the mechanisms involved in this association are not yet sufficiently established. Therefore, further research should be focused on understanding the possible mechanisms involved.

Prevalence of Migraine and its Relationship with Psychological Stress and Sleep Quality in Female University Students in Saudi Arabia

Purpose

This study aimed to determine the prevalence of migraine in young female adults and to identify if a relationship exists between psychological stress or poor sleep quality and migraine.

Materials and Methods

This case control study was carried out at Imam Abdulrahman Bin Faisal University (IAU), Dammam, KSA from March 2019 to March 2020 on 1,990 female students (17- to 26-years-old). The study tools were Migraine Screening Questionnaire (MS-Q), International Headache Society (IHS) Criteria for Migraine, K10 Psychological Distress Instrument (K10) and Pittsburgh Sleep Quality Index (PSQI).

Results

A total of 103 out of 1,990 (5.17%) participants were identified to have migraine. Migraineurs compared to controls had significantly higher average stress scores; felt more tired, nervous, restless, could not sit still, felt that everything was an effort, and nothing cheered them up (p values; 0.008, 0.001, 0.02, 0.01, 0.004, 0.009, 0.02 respectively). Moreover, presence of migraine was significantly correlated with various stress parameters including "High K10 scores," "being tired," "being nervous," "restlessness," "inability to sit still," and "feeling that everything is an effort" (p values: 0.01, 0.002, 0.018, 0.01,0.005, 0.01,0.02). Regarding sleep quality and sleep parameters, no statistically significant difference was found between migraineurs and controls. No correlation was found between presence of migraine and poor sleep quality.

Conclusions

The results of this study indicate that 5.17% of young females (17- to 26-years-old) suffer from migraine. It also concludes that poor sleep quality is not correlated with migraine, whereas high stress scores are significantly correlated with migraine in young female adults.

Associations Between Sleep Quality and Migraine Frequency: A Cross-Sectional Case-Control Study

Migraine has been associated with sleep disturbances. Relationship between sleep quality and migraine frequency is yet to be determined. The present study aimed to investigate sleep disturbances among low-frequency, moderate-frequency, high-frequency, and chronic migraineurs, with and without auras, with well-controlled confounding variables.This cross-sectional controlled study included 357 subjects from an outpatient headache clinic in Taiwan. Standardized questionnaires were utilized to collect demographic, migraine, sleep, depression, anxiety, and restless leg syndrome characteristics in all participants. According to frequency of migraine attacks, patients were divided into 4 groups: with 1 to 4 migraine days per month, 5 to 8 migraine days in a month, 9 to 14 migraine days in a month, and >14 migraine days per month. The Pittsburgh Sleep Quality Index (PSQI) and subgroup items were used to evaluate sleep quality. The association between migraine frequency and sleep quality was investigated using multivariable linear regression and logistic regression.The PSQI total score was highest in patients with high frequent migraine (10.0 ± 3.4) and lowest in controls (7.0 ± 3.4) with a significant trend analysis (P for trend = 0.006). Migraine frequency had an independent effect on the items "Cannot get to sleep within 30 minutes" (P < 0.001), "Wake up in the middle of the night or early morning" (P < 0.001), "Bad dreams" (P = 0.001), "Pain" (P = 0.004), and "Quality of sleep" (P < 0.001). The result showed the effect of migraine frequency in both the aura-present (P for trend = 0.008) and the aura-absent subgroups (P for trend = 0.011).High migraine frequency correlates with poor sleep quality and a higher prevalence of poor sleepers. These associations occur in migraine with aura and without aura.

Migraine and the Hypothalamus

Migraine is a complex brain disorder where several neuronal pathways and neurotransmitters are involved in the pathophysiology. To search for a specific anatomical or physiological defect in migraine may be futile, but the hypothalamus, with its widespread connections with other parts of the central nervous system and its paramount control of the hypophysis and the autonomic nervous system, is a suspected locus in quo. Several lines of evidence support involvement of this small brain structure in migraine. However, whether it plays a major or minor role is unclear. The most convincing support for a pivotal role so far is the activation of the hypothalamus shown by positron emission tomography (PET) scanning during spontaneous migraine attacks. A well-known theory is that the joint effect of several triggers may cause temporary hypothalamic dysfunction, resulting in a migraine attack. If PET scanning had consistently confirmed hypothalamic activation prior to migraine headache, this hypothesis would have been supported. However, such evidence has not been provided, and the role of the hypothalamus in migraine remains puzzling. This review summarizes and discusses some of the clues.