Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders

Interactive effect of sleep duration, lifestyle factors and comorbidity on depressive symptoms: Insights from the China health and retirement longitudinal study

BACKGROUND

As population aging intensifies, depression emerges as a major global public health issue, especially affecting middle-aged and elderly individuals. While studies have investigated factors like sleep duration, physical activity, smoking, drinking habits, and comorbidity, the complex interplay and cumulative effect of these factors on the risk of depressive symptoms remain not fully understood.

METHODS

This research utilizes data from the China Health and Retirement Longitudinal Study (CHARLS), encompassing observations from 2015 to 2020. The subjects included 8234 middle-aged and elderly individuals, accounting for a total of 22,570 observations. Lifestyle factors were represented by physical activity, smoking, and drinking habits, with the volume of moderate-to-vigorous physical activity (MVPA) quantified by quoting metabolic equivalents (MET). Multivariate logistic regression models were conducted for baseline analysis, and mixed-effects logistic regression models with random participant intercepts were constructed for the longitudinal analysis of the cohort. Moreover, interaction terms between these factors were included to assess their combined impact on the risk of depressive symptoms.

RESULTS

Longitudinal analysis revealed a notable correlation between short sleep duration (<7 h) and an elevated risk of depressive symptoms, evidenced by an adjusted odds ratio (OR) of 3.13 (95 % CI: 2.73-3.74). Conversely, long sleep duration (>9 h) was not associated with a marked change in risk of depressive symptoms (OR = 1.11, 95 % CI: 0.78-1.59, p = 0.59). High levels of physical activity (192-336 MET-h/week) were significantly linked to an elevated risk of depressive symptoms (OR = 1.70, 95 % CI: 1.19-2.42). Discontinuing smoking was significantly correlated with a lower risk of depressive symptoms (OR = 0.68, 95 % CI: 0.52-0.90). Subjects with two or more concurrent conditions exhibited a substantially higher risk of depressive symptoms (OR = 3.19, 95 % CI: 3.13-3.25). Investigating the combined influence of sleep duration, lifestyle elements, and concurrent conditions revealed that enhanced physical activity levels significantly decreased risk of depressive symptoms in participants with short sleep duration, adjusting the OR from 3.16 to 0.83 (95 % CI, 0.53-1.30). Among participants with short sleep duration, smoking and alcohol consumption patterns were linked to a decreased risk of depressive symptoms, although these associations lacked statistical significance. Relative to subjects without concurrent conditions, those harboring two or more such conditions faced a significantly heightened risk of depressive symptoms in the context of short sleep duration (OR = 3.00, 95 % CI: 2.24-4.03), a risk not observed in subjects with extended sleep duration. Moderate napping (0.5-1 h) among participants with short sleep duration was found to significantly mitigate risk of depressive symptoms (OR = 0.64, 95 % CI: 0.44-0.95), whereas in subjects with prolonged sleep duration, extended napping did not significantly alter risk of depressive symptoms.

LIMITATIONS

The results, derived from a middle-aged and elderly Chinese population, may not be generalizable to other demographic groups or cultural contexts.

CONCLUSION

This study shows that short sleep duration, unhealthy lifestyle factors, and comorbidities significantly increase the risk of depressive symptoms in middle-aged and elderly individuals. Moderate physical activity, smoking cessation, moderate drinking, and appropriate napping can mitigate this risk, especially for those with short sleep duration. These findings highlight the need to address sleep quality, promote healthy habits, and manage comorbidities in mental health interventions for this population.

The S-shaped association between dietary caffeine intake and severe headache or migraine: a cross-sectional study based on NHANES

Background and purpose

Severe headache or migraine is a highly prevalent neurological disorder that significantly impacts the daily lives of those affected. Currently, there remains a debate regarding the relationship between daily caffeine intake and severe headache or migraine. This study aims to determine the relationship between caffeine intake and severe headache or migraine to inform dietary interventions.

Materials and methods

The study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2004, involving a total of 5,234 participants aged 20-49 years. A multivariable logistic regression model was employed to examine the relationship between dietary caffeine intake and severe headache or migraine. A restricted cubic spline (RCS) regression model was used to explore potential dose-response relationships. A smoothed two-piece logistic regression model was applied to identify threshold associations between dietary caffeine intake and severe headache or migraine. Subgroup regression analyses were conducted to investigate whether the impact of dietary caffeine intake on severe headache or migraine varied among different subgroups.

Results

Among the 5,234 participants, 26.69% (1,397/5234) had severe headache or migraine. Compared to individuals with lower caffeine intake (quartile [Q]1, ≤1.81 mg/d), those with higher caffeine intake in Q2 (1.81-45.48 mg/d), Q3 (45.48-125.95 mg/d), and Q4 (≥125.95 mg/d) had adjusted odds ratios for severe headache or migraine of 1.1487 (95% confidence interval [CI]: 0.9532-1.3845, p = 0.1454), 1.4370 (95% CI: 1.1921-1.7335, p = 0.001), and 1.5642 (95% CI: 1.2842-1.9067, p < 0.001), respectively. The relationship between dietary caffeine intake and severe headache or migraine in U.S. adults exhibits an S-shaped pattern, with a turning point at approximately 97.5 mg/d.

Conclusion

These results suggest an S-shaped association between dietary caffeine intake and severe headache or migraine. Individuals who routinely consume caffeine in their diet should be vigilant about the risk of experiencing severe headaches or migraines.

Burden of migraine among Egyptian people: prevalence and comorbidities

INTRODUCTION

Migraine is a prevalent debilitating neurological illness that stands among the top causes of disability and significantly impacts the quality of life. Migraine-related functional impairment involves physical, emotional, and economic consequences that frequently impact occupational, academic, social, and familial aspects of life. Depression, anxiety, and sleep disturbances are among the most common comorbid conditions associated with migraine.

OBJECTIVE

This study aimed to assess the prevalence of migraine among the Egyptian population and associated comorbidities.

METHODS

we conducted a cross-sectional study using a validated Arabic self-administered questionnaire distributed to the general population. The questionnaire was used to collect data on sociodemographic characteristics, migraine frequency, characteristic associated disability, insomnia, and psychological factors. Convenience snowball sampling method was utilized. Univariate and multivariate regression analyzes were applied.

RESULTS

A total of 2,533 participants were included in the final analysis from five Egyptian regions. Females represent 57%. More than one-half of participants (59.1%) aged 20-30 years. The prevalence of migraine was 20.9%. The most common triggers were sleep disorders (76.9%), followed by perceived noise (65%), and anxiety (59%). Among the participants diagnosed with migraine, 46.7% had a severe disability, 22% had clinical insomnia of moderate severity, 20.5% had severe depression, 29% had severe anxiety, and 20.6% had severe stress. Females, older age, and urban residents were the key predictors of migraine. Lifestyle factors including regular physical activity and good hydration were linked to reduced migraine risk. Comorbid conditions including insomnia, stress, and anxiety significantly impacted migraine severity.

CONCLUSION

Our results showed a 20.9% prevalence of migraine, with nearly one-half of cases associated with severe disability, along with comorbidities like depression, anxiety, and insomnia. Female gender, older age, and urban residence are key predictors, while lifestyle factors such as physical exercise and good hydration reduce the risk of migraine.

The role and interaction of hypothalamic-related neurotransmitters in migraine

Migraine is a complex neurological disorder frequently associated with hypothalamic dysfunction. This brain region is essential for maintaining homeostasis due to its regulation of autonomic, endocrine, and circadian systems. While the pathophysiology of migraine remains incompletely understood, clinical features such as the cyclic nature of attacks and symptoms, including nausea, vomiting, yawning, irritability, and sensitivity to light, indicate a significant role for the hypothalamus. Further, potential triggers of migraine, such as stress and disruption to feeding habits, also impact hypothalamic mechanisms. The higher prevalence of migraine in women compared to men suggests a link to hormonal fluctuations involving estrogen, progesterone, and prolactin. These hormones interact with the hypothalamus, potentially influencing the onset and severity of migraine episodes. Additionally, the hypothalamus synthesizes neuropeptides such as orexins, neuropeptide Y, PACAP, oxytocin, and vasopressin, which are all implicated in migraine mechanisms. Understanding the interplay between the hypothalamus, sex hormones, and neuropeptides offers valuable opportunities for endogenous targeted migraine therapies. In this review we discuss hypothalamic contributions to migraine pathophysiology, highlighting the mechanisms affected by hypothalamic connections, neuropeptides, and hormones, and their role as migraine triggers, particularly focusing on factors like stress, fasting, and changes in sleep patterns.

Exploring the association between dietary caffeine and chronic musculoskeletal pain: a cross-sectional analysis of NHANES

Background

The association between dietary caffeine intake and chronic musculoskeletal pain (CMP) remains unclear, with previous studies yielding conflicting results. This study aims to investigate the association between dietary caffeine intake and CMP.

Methods

This cross-sectional study utilized data from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) in the United States. We employed multivariable logistic regression models, restricted cubic spline regression (RCS), stratified analysis, and sensitivity analysis to evaluate the association between dietary caffeine intake and CMP.

Results

The study comprised 3,797 participants, with a mean age of 50.11 ± 17.57 years and a CMP prevalence of 18.41%. After full adjustment, multivariable logistic regression and RCS regression indicated a linear positive correlation between dietary caffeine intake and CMP. For each one-unit increase in log-transformed dietary caffeine intake, the risk of CMP increased by 8.35% (OR: 1.0835, 95% CI: 1.0351, 1.1358). Compared with the Q1 (-1.00-5.44 mg/d), the ORs for individuals in the Q2 (5.45-6.83 mg/d), Q3 (6.84-7.85 mg/d), and Q4 (7.86-11.48 mg/d) were 1.1556 (95% CI: 0.8866, 1.5075, p = 0.2852), 1.4256 (95% CI: 1.1006, 1.8505, p = 0.0074), and 1.5238 (95% CI: 1.1685, 1.9920, p = 0.0020), respectively. Additionally, stratified and sensitivity analyses yielded similar results.

Conclusion

The study revealed a positive relationship between dietary caffeine intake and CMP, suggesting that higher caffeine consumption may be linked to an increased risk of CMP. Based on these findings, CMP patients may benefit from reducing their caffeine intake.

Assessment of sleep patterns in migraine sufferers using the Epworth Sleepiness Scale

BACKGROUND

Migraine, a debilitating neurological disorder, is often co-occurring with sleep disturbances. This study used the Epworth Sleepiness Scale (ESS) to explore changes in sleep quality between individuals with migraine and healthy controls. Additionally, we examined associations between ESS scores and migraine frequency, severity, and demographic factors.

METHODS

This cross-sectional study included 404 participants, 204 with chronic migraine (diagnosed using ICHD-3 criteria) and 200 controls without neurological disorders. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Demographic and clinical data were analyzed using Python3 and SPSS, using t-tests and ANOVA (P < 0.05).

RESULTS

The study analyzed demographics, clinical characteristics, and daytime sleepiness in 204 migraine participants compared with 200 controls. Individuals with chronic migraine had higher Epworth Sleepiness Scale scores, with increased sleepiness associated with higher BMI, age, and female gender. Significant differences in sleepiness levels were observed with migraine severity, highlighting the impact of migraine on sleep patterns and quality, and no significant differences were found between control and migraine groups in ESS scores, sleep duration, or physical activity. Reliability testing confirmed high ESS consistency.

CONCLUSION

This study highlights the prevalence of daytime sleepiness among individuals with chronic. Managing sleep quality emerges as an important treatment strategy. The use of standardized tools such as the Epworth Sleep Scale can guide personalized interventions, improve patient outcomes, and emphasize the role of lifestyle and overall health management.

Exploring the evolving frontiers of sleep deprivation research in the post-COVID-19 era

Sleep deprivation research (SDR) has undergone substantial transformations in the aftermath of the COVID-19 pandemic. This comprehensive study explores the SDR's evolving trends, hotspots, and conceptual structure in the post-COVID-19 era. Using bibliometric analysis with VOSviewer and Bibliometrix software, we examined the SDR publications from January 2020 to December 2023. Core sources were identified using Bradford law, and a dataset of 4578 English-based data-driven studies was retrieved from the Scopus database. Our analysis revealed a remarkable annual growth rate of 37.92% in SDR from 2020 to 2023, indicating a heightened research focus in this domain. Among prolific authors, Shao emerged as a key contributor, while Sleep ranked prominently as a leading publication venue. The United States and China have emerged as the most impactful countries for advancing SDR research. Uncovering the most cited documents sheds light on various focal points within SDR, including sleep duration, mental health implications, cardiovascular events, the impact of COVID-19 on sleep patterns, dementia, resilience in children, and sleep patterns among preschoolers. Noteworthy keywords that emerged from the analysis encompassed "sleep deprivation," "depression," "insomnia," "COVID-19," "anxiety," "fatigue," and "obesity." Using a thematic mapping approach, we delineated distinct themes characterized by niche, basic, emerging, and declining patterns. Clusters of SDR research were observed in areas such as "Fatigue," "Sleep apnea," "Sleep," "Sleep deprivation," "Migraine," "Caffeine," and "Recovery." Furthermore, trending themes in SDR encompassed "Sleep disturbance," "excessive daytime sleepiness," and "Gamma-Aminobutyric Acid." These comprehensive findings provide valuable insights into the current landscape of SDR, illuminating emerging trends, identifying hotspots, and offering directions for future research in this critical field.

Current Trends in Pediatric Migraine: Clinical Insights and Therapeutic Strategies

Background/Objectives: Pediatric migraine is a prevalent neurological disorder that significantly impacts children's quality of life, academic performance, and social interactions. Unlike migraines in adults, pediatric migraines often present differently and involve unique underlying mechanisms, making diagnosis and treatment more complex. Methods: This review discusses the clinical phases of pediatric migraine, key trigger factors, sex- and age-related differences, and the role of childhood maltreatment in migraine development. We also discuss episodic syndromes such as cyclic vomiting syndrome, abdominal migraine, benign paroxysmal vertigo, and benign paroxysmal torticollis, along with comorbidities such as psychiatric disorders, sleep disturbances, and epilepsy. Results: The underlying pathophysiological mechanisms for pediatric migraines, including genetic predispositions, neuroinflammation, and gut microbiota dysbiosis, are summarized. Current therapeutic strategies, including conventional and emerging pharmacological treatments, nutraceuticals, and non-pharmacological approaches, are evaluated. Non-pharmacological strategies, particularly evidence-based lifestyle interventions such as stress management, diet, hydration, sleep, exercise, screen time moderation, and cognitive behavioral therapy, are highlighted as key components of migraine prevention and management. The long-term prognosis and follow-up of pediatric migraine patients are reviewed, emphasizing the importance of early diagnosis, and tailored multidisciplinary care to prevent chronic progression. Conclusions: Future research should focus on novel therapeutic targets and integrating gut-brain axis modulation, with a need for longitudinal studies to better understand the long-term course of pediatric migraine.

Sleep Disturbance in Vestibular Migraine and Meniere's Disease: A Comparative Analysis

OBJECTIVE

To investigate the differences in the prevalence of sleep disturbance between vestibular migraine (VM) and Meniere's disease (MD), and to determine whether poor sleep quality is correlated with dizziness handicap.

STUDY DESIGN

Observational prospective study.

SETTING

Tertiary Academic Medical Center.

METHODS

Patients diagnosed with VM, MD, and healthy controls completed the Mini Sleep Questionnaire (MSQ), which comprises 10 items assessing sleep quality. The MSQ total score was calculated by summing the scores of each item. The Dizziness Handicap Inventory (DHI) was used to evaluate the physical, emotional, and functional impacts of dizziness on daily life.

RESULTS

A total of 87 participants (35 with VM, 39 with MD, and 13 healthy controls) were enrolled. Both the VM and MD groups had significantly higher MSQ total scores than the control group (P < .001). The VM group exhibited a higher prevalence of "difficulty falling asleep" (P = .015) and "headaches on awakening" (P = .012) than the MD group. Additionally, the MSQ total score was significantly correlated with the DHI total score in VM patients (P = .001, r = .518). VM patients with severe dizziness handicap had significantly higher MSQ total scores than those with mild handicap (P = .005).

CONCLUSION

This study highlights the high prevalence of sleep disturbance in both VM and MD patients. The severity of sleep disturbance is correlated with dizziness handicap in VM patients, emphasizing the importance of assessing sleep quality and promoting good sleep habits in the management of VM.

Clinical impact of restless legs syndrome in patients with migraine: a 12-year, single-center, longitudinal study

Although many studies have indicated a significant association between migraine and restless legs syndrome (RLS), few long-term longitudinal studies have examined RLS in patients with migraine. We conducted a single-center, 12-year, longitudinal study of migraine patients and assessed whether RLS was present in 2010, 2017, or 2022 to evaluate its associations with clinical factors. Headache-related disability was assessed using the Migraine Disability Assessment (MIDAS). Sleep quality, daytime sleepiness, and depressive symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Beck Depression Inventory-II (BDI-II), respectively. Of the 262 patients included at baseline (2010), 101 were available after 7 years (2017), and 74 were available after 12 years (2022). The RLS incidence rates were 13.7%, 20.8%, and 24.3% in 2010, 2017, and 2022, respectively. The RLS severity score did not significantly differ among the three time points. The persistent RLS group, defined as those who were positive for RLS at the last evaluation in addition to the first and/or second evaluations, had significantly higher MIDAS, BDI-II, PSQI and ESS scores than did the never RLS group, defined as those who did not exhibit RLS at any of the three time points. Our 12-year longitudinal study revealed significant impacts of RLS on the burden of patients with migraine.

German language adaptation of the Cogniphobia Scale for Headache Disorders (CS-HD) and development of a new short form (CS-HD-6)

OBJECTIVE

This study is part of the ODIN-migraine (Optimization of Diagnostic Instruments in migraine) project. It is a secondary, a priori analysis of previously collected data, and aimed to assess the psychometric properties and factor structure of the Cogniphobia Scale for Headache Disorders (CS-HD). We aimed to construct a German-language version and a short version.

BACKGROUND

Cogniphobia is the fear and avoidance of cognitive exertion, which the patient believes triggers or exacerbates headache. High cogniphobia may worsen the course of a headache disorder.

METHODS

The 15-item CS-HD was translated into German and back translated in a masked form by a professional translator. Modifications were discussed and carried out in an expert panel. A cross-sectional online survey including the CS-HD and further self-report questionnaires was conducted in a sample of N = 387 persons with migraine (364/387 [94.1%] female, M = 41.0 [SD = 13.0] years, migraine without aura: 152/387 [39.3%], migraine with aura: 85/387 [22.0%], and chronic migraine: 150/387 [38.8%]).

RESULTS

Exploratory factor analysis resulted in two clearly interpretable factors (interictal and ictal cogniphobia). Confirmatory factor analysis yielded an acceptable to good model fit (χ2(89) = 117.87, p = 0.022, χ2/df = 1.32, RMSEA = 0.029, SRMR = 0.055, CFI = 0.996, TLI = 0.995). Item response theory-based analysis resulted in the selection of six items for the short form (CS-HD-6). Reliability was acceptable to excellent (interictal cogniphobia subscale: ω = 0.92 [CS-HD] or ω = 0.77 [CS-HD-6]; ictal cogniphobia subscale: ω = 0.77 [CS-HD] or ω = 0.73 [CS-HD-6]). The pattern of correlations with established questionnaires confirmed convergent validity of both the CS-HD and the CS-HD-6.

CONCLUSION

Both the CS-HD and the CS-HD-6 have good psychometric properties and are suitable for the assessment of cogniphobia in migraine.

Poor healthy lifestyle and life's essential 8 are associated with higher risk of new-onset migraine: a prospective cohort study

BACKGROUND

Lifestyle are closely related to migraine. However, there is a lack of studies investigating the association between Healthy lifestyle or Life's Essential 8 (LE8) and the risk of migraine. The objective of this research was to investigate the relationship between Healthy lifestyle scores and Life's essential 8 scores, and migraine.

METHODS

332,895 UK Biobank participants without migraine were included. Healthy lifestyle were assessed using seven lifestyle factors, and categorized as poor, intermediate, or ideal. LE8, based on the American Heart Association (AHA) Guidelines for Cardiovascular Health (CVH), consist of eight indicators classified as low, moderate, or high CVH. The Cox proportional hazard model was employed to examine the association between Healthy lifestyle scores, LE8 scores, and migraine, with calculations for population-attributable fraction (PAF) and cumulative incidence.

RESULTS

During a median follow-up of 13.58 years, participants in intermediate (HR: 0.91; 95% CI: 0.85, 0.99) or ideal category of Healthy lifestyle (HR: 0.81; 95% CI: 0.73, 0.91) significantly reduced migraine risk compared to the poor category. Similarly, high CVH (HR: 0.73; 95% CI: 0.58, 0.92) also lowered migraine risk, while moderate CVH (HR: 0.93; 95% CI: 0.85, 1.02) did not show a difference compared to low CVH. If all individuals adhered to higher categories of Healthy lifestyle and LE8, approximately 11.38% and 22.05% of migraine cases could be prevented. Among individual lifestyle factors, maintaining an ideal body mass index (BMI), physical activity, sleep duration, sleep pattern, and sedentary time were associated with substantial reductions in migraine risk, by 5.65%, 0.81%, 10.16%, 16.39%, and 6.57%, respectively.

CONCLUSION

Our study provides evidence that poor Healthy lifestyle and Life's Essential 8 are associated with higher risk of new-onset migraine.

Clinical usefulness of dual orexin receptor antagonism beyond insomnia: Neurological and psychiatric comorbidities

Orexin is a neurotransmitter produced by a small group of hypothalamic neurons. Besides its well-known role in the regulation of the sleep-wake cycle, the orexin system was shown to be relevant in several physiological functions including cognition, mood and emotion modulation, and energy homeostasis. Indeed, the implication of orexin neurotransmission in neurological and psychiatric diseases has been hypothesized via a direct effect exerted by the projections of orexin neurons to several brain areas, and via an indirect effect through orexin-mediated modulation of sleep and wake. Along with the growing evidence concerning the use of dual orexin receptor antagonists (DORAs) in the treatment of insomnia, studies assessing their efficacy in insomnia comorbid with psychiatric and neurological diseases have been set in order to investigate the potential impact of DORAs on both sleep-related symptoms and disease-specific manifestations. This narrative review aimed at summarizing the current evidence on the use of DORAs in neurological and psychiatric conditions comorbid with insomnia, also discussing the possible implication of modulating the orexin system for improving the burden of symptoms and the pathological mechanisms of these disorders. Target searches were performed on PubMed/MEDLINE and Scopus databases and ongoing studies registered on Clinicaltrials.gov were reviewed. Despite some contradictory findings, preclinical studies seemingly support the possible beneficial role of orexin antagonism in the management of the most common neurological and psychiatric diseases with sleep-related comorbidities. However, clinical research is still limited and further studies are needed for corroborating these promising preliminary results.

Association Between Electronic Diary-Rated Sleep, Mood, Energy, and Stress With Incident Headache in a Community-Based Sample

BACKGROUND AND OBJECTIVES

The aim of this study was to examine the diurnal links between average and changes in average levels of prospectively rated mood, sleep, energy, and stress as predictors of incident headache in a community-based sample.

METHODS

This observational study included structured clinical diagnostic assessment of both headache syndromes and mental disorders and electronic diaries that were administered 4 times per day for 2 weeks yielding a total of 4,974 assessments. The chief outcomes were incident morning (am) and later-day (pm) headaches. Generalized linear mixed-effects models were used to evaluate the average and lagged values of predictors including subjectively rated mood, anxiety, energy, stress, and sleep quality and objectively measured sleep duration and efficiency on incident am and pm headaches.

RESULTS

The sample included 477 participants (61% female), aged 7 through 84 years. After adjusting for demographic and clinical covariates and emotional states, incident am headache was associated with lower average (ß = -0.206*; confidence intervals: -0.397 to -0.017) and a decrease in average sleep quality on the prior day (ß = -0.172*; confidence interval: -0.305, -0.039). Average stress and changes in subjective energy levels on the prior day were associated with incident headaches but with different valence for am (decrease) (ß = -0.145* confidence interval: -0.286, -0.005) and pm (increase) (ß = 0.157*; confidence interval: 0.032, 0.281) headache. Mood and anxiety disorders were not significantly associated with incident headache after controlling for history of a diagnosis of migraine.

DISCUSSION

Both persistent and acute changes in arousal states manifest by subjective sleep quality and energy are salient precursors of incident headaches. Whereas poorer sleep quality and decreased energy on the prior day were associated with incident morning headache, an increase in energy and greater average stress were associated with headache onsets later in the day. Different patterns of predictors of morning and later-day incident headache highlight the role of circadian rhythms in the manifestations of headache. These findings may provide insight into the pathophysiologic processes underlying migraine and inform clinical intervention and prevention. Tracking these systems in real time with mobile technology provides a valuable ancillary tool to traditional clinical assessments.

Associations between the burdens of comorbid sleep problems, central sensitization, and headache-related disability in patients with migraine

Objective

Sleep disturbances are common in migraine patients and affect quality of life. Central sensitization (CS) is likely to play a role in the increased severity and chronicity of migraine. We hypothesized that the number of comorbid sleep problems would affect headache-related disability through the effects of central sensitization (CS).

Methods

We performed a cross-sectional study including 215 consecutive patients with migraine. Insomnia was defined as a Pittsburgh Sleep Quality Index (PSQI) global score greater than 5. Probable REM sleep behavior disorder (pRBD) was defined as an RBD screening score of 5 or greater. Excessive daytime sleepiness (EDS) was defined as an Epworth Sleepiness Scale score of 10 or higher. Suspected sleep apnea (SA) was defined as patients with snoring or sleep apnea witnessed 3 or more nights a week. CS was assessed by the Central Sensitization Inventory (CSI).

Results

Restless legs syndrome, insomnia, EDS, SA and pRBD were observed in 25.6%, 71.6%, 34.4%, 10.2%, and 21.4%, respectively, of the patients. At least one sleep problem was present in 87.0% of the patients. According to the results of the multinomial logistic regression analysis with no sleep problems as a reference, after we corrected for adjustment factors, the Migraine Disability Assessment (MIDAS) score significantly increased when three or more comorbid sleep problems were present. According to our mediation analysis, an increased number of sleep problems had a direct effect on the MIDAS score after we adjusted for other variables, and the CSI score was indirectly involved in this association.

Conclusion

The present study showed an association between migraine-related disability and the burden of multiple sleep problems, which was partially mediated by CS.

The long-term effect of work schedule, shift work disorder, insomnia and restless legs syndrome on headache among nurses: A prospective longitudinal cohort study

BACKGROUND

The preset study aimed to explore whether work schedules and sleep disorders predict the onset of headache.

METHODS

A longitudinal study was conducted with questionnaire data from 2014 (baseline) and 2017 (follow-up) on work schedule, number of night shifts, number of quick returns, insomnia, shift work disorder (SWD), restless legs syndrome (RLS) and validated headache diagnoses among 1560 Norwegian nurses. Associations were explored by multivariate regression analyses.

RESULTS

Work related factors at baseline did not predict onset of headache three years later. In the adjusted logistic regressions, insomnia at baseline predicted increased risk of new onset of migraine (odds ratio (OR) = 1.58; 95% confidence interval (CI) = 1.08-2.33), chronic headache (OR = 2.02; 95% CI = 1.04-4.66) and medication-overuse headache (OR = 3.79; 95% CI = 1.26-11.42) at follow-up. SWD at baseline predicted new onset of migraine (OR = 1.64; 95% CI = 1.07-2.50) and RLS at baseline predicted new onset of headache ≥1 day per month (OR = 1.55; 95% CI = 1.01-2.36) and migraine (OR = 1.55; 95% CI = 1.03-2.32) at follow-up. No factors predicted tension-type headache.

CONCLUSIONS

Overall, work related factors did not predict the onset of headache three years later, whereas insomnia, SWD and RLS at baseline all increased the risk of future headaches.

Risk factors for migraine disease progression: a narrative review for a patient-centered approach

BACKGROUND

In individuals with migraine, attacks may increase in frequency, severity, or both. Preventing migraine progression has emerged as a treatment goal in headache subspecialty practice, but there may be less awareness in general neurology or primary care settings where most people with migraine who seek treatment consult. Herein, we review the definition of and risk factors for migraine progression and consider strategies that could reduce its risk.

METHODS

A group of headache expert healthcare professionals, clinicians, and researchers reviewed published evidence documenting factors associated with increased or decreased rates of migraine progression and established expert opinions for disease management recommendations. Strength of evidence was rated as good, moderate, or based solely on expert opinion, using modified criteria for causation developed by AB Hill.

RESULTS

Migraine progression is commonly operationally defined as the transition from ≤ 15 to ≥ 15 monthly headache days among people with migraine; however, this does not necessarily constitute a fundamental change in migraine biology and other definitions should be considered. Established and theoretical key risk factors for migraine progression were categorized into five domains: migraine disease characteristics, treatment-related factors, comorbidities, lifestyle/exogenous factors, and demographic factors. Within these domains, good evidence supports the following risk factors: poorly optimized acute headache treatment, cutaneous allodynia, acute medication overuse, selected psychiatric symptoms, extra-cephalic chronic pain conditions, metabolism-related comorbidities, sleep disturbances, respiratory conditions, former/current high caffeine intake, physical inactivity, financial constraints, tobacco use, and personal triggers as risk factors. Protective actions that may mitigate migraine progression are sparsely investigated in published literature; our discussion of these factors is primarily based on expert opinion.

CONCLUSIONS

Recognizing risk factors for migraine progression will allow healthcare providers to suggest protective actions against migraine progression (Supplementary Fig. 1). Intervention studies are needed to weight the risk factors and test the clinical benefit of hypothesized mitigation strategies that emerge from epidemiological evidence.

Development and validation of non-invasive prediction models for migraine in Chinese adults

BACKGROUND

Migraine is a common disabling neurological disorder with severe physical and psychological damage, but there is a lack of convenient and effective non-invasive early prediction methods. This study aimed to develop a new series of non-invasive prediction models for migraine with external validation.

METHODS

A total of 188 and 94 subjects were included in the training and validation sets, respectively. A standardized professional questionnaire was used to collect the subjects' 9-item traditional Chinese medicine constitution (TCMC) scores, Pittsburgh Sleep Quality Index (PSQI) score, Zung's Self-rating Anxiety Scale and Self-rating Depression Scale scores. Logistic regression was used to analyze the risk predictors of migraine, and a series of prediction models for migraine were developed. Receiver operating characteristic (ROC) curve and calibration curve were used to assess the discrimination and calibration of the models. The predictive performance of the models were further validated using external datasets and subgroup analyses were conducted.

RESULTS

PSQI score and Qi-depression score were significantly and positively associated with the risk of migraine, with the area of the ROC curves (AUCs) predicting migraine of 0.83 (95% CI:0.77-0.89) and 0.76 (95% CI:0.68-0.84), respectively. Eight non-invasive predictive models for migraine containing one to eight variables were developed using logistic regression, with AUCs ranging from 0.83 (95% CI: 0.77-0.89) to 0.92 (95% CI: 0.89-0.96) for the training set and from 0.76 (95% CI: 0.66-0.85) to 0.83 (95% CI: 0.75-0.91) for the validation set. Subgroup analyses showed that the AUCs of the eight prediction models for predicting migraine in the training and validation sets of different gender and age subgroups ranged from 0.80 (95% CI: 0.63-0.97) to 0.95 (95% CI: 0.91-1.00) and 0.73 (95% CI: 0.64-0.84) to 0.93 (95% CI: 0.82-1.00), respectively.

CONCLUSIONS

This study developed and validated a series of convenient and novel non-invasive prediction models for migraine, which have good predictive ability for migraine in Chinese adults of different genders and ages. It is of great significance for the early prevention, screening, and diagnosis of migraine.

New management strategies for primary headache disorders: Insights from P4 medicine

Primary headache disorder is the main cause of headache attacks, leading to significant disability and impaired quality of life. This disorder is increasingly recognized as a heterogeneous condition with a complex network of genetic, environmental, and lifestyle factors. However, the timely diagnosis and effective treatment of these headaches remain challenging. Precision medicine is a potential strategy based on P4 (predictive, preventive, personalized, and participatory) medicine that may bring new insights for headache care. Recent machine learning advances and widely available molecular biology and imaging data have increased the usefulness of this medical strategy. Precision medicine emphasizes classifying headaches according to their risk factors, clinical presentation, and therapy responsiveness to provide individualized headache management. Furthermore, early preventive strategies, mainly utilizing predictive tools, are critical in reducing headache attacks and improving the quality of life of individuals with headaches. The current review comprehensively discusses the potential application value of P4 medicine in headache management.

Effects of acupuncture on mental health of migraine patients: a systematic review and meta-analysis

BACKGROUND

Migraine is a neurological disease characterized by moderate to severe headache and various neurological symptoms. It is often cause mood and anxiety disorders that can seriously affect quality of life. Acupuncture has been claimed to have a role in treating neuropsychiatric disorders and is becoming increasingly popular. However, it remains unclear whether current evidence is sufficient to support acupuncture in improving mental health in migraine patients.

OBJECTIVES

This systematic review and meta-analysis aimed to investigate the effect of acupuncture on the management of pain and mood disorders in patients with migraine.

METHODS

We searched PubMed, Cochrane Library, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI) and Wan Fang Data Knowledge Service Platform for reports, conferences and academic papers published before January 1, 2022. Randomized controlled trials (RCTs) including acupuncture, sham acupuncture and medication for migraine were included. Stata 16.0 software and Cochrane RoB2.0 were used for data processing and migration risk analysis.

RESULT

Thirteen randomized controlled trials containing 1766 migraine patients were included in the present study, the results showed that compared with sham acupuncture and medication, acupuncture seemed to have advantage in improving SAS (WMD: -5.64;95% CI: -10.89, -0.39; p = 0.035) and SDS (WMD: -4.65; 95% CI: -9.25, -0.05; p = 0.048) in migraine patients. And it seems to be more effective in improving MH (SMD: 0.77; 95% CI: 0.19, 1.35; p = 0.009), VAS (SMD: -1.06; 95% CI: -1.73, -0.4; p = 0.002;) and MSQ (WMD: 4.76; 95% CI: 2.36, 7.15; p < 0.001) than sham acupuncture and medication.

CONCLUSION

The present results suggest that, compared with Western medicine and sham acupuncture, acupuncture seems to be able to effectively improve anxiety and depression in migraine patients.And it may be more effective in improving SF36-mental health, VAS and MSQ than shame acupuncture or Western medicine. The results of this study need to be verified by higher quality RCTs.

Tools to guide clinical discussions on physical activity, sedentary behaviour, and/or sleep for health promotion between primary care providers and adults accessing care: a scoping review

BACKGROUND

Health care providers have reported low knowledge, skill, and confidence for discussing movement behaviours (i.e., physical activity, sedentary behaviour, and sleep), which may be improved with the use of tools to guide movement behaviour discussions in their practice. Past reviews have examined the psychometric properties, scoring, and behavioural outcomes of physical activity discussion tools. However, the features, perceptions, and effectiveness of discussion tools for physical activity, sedentary behaviour, and/or sleep have not yet been synthesized. The aim of this review was to report and appraise tools for movement behaviour discussions between health care providers and adults 18 + years in a primary care context within Canada or analogous countries.

METHODS

An integrated knowledge translation approach guided this review, whereby a working group of experts in medicine, knowledge translation, communications, kinesiology, and health promotion was engaged from research question formation to interpretation of findings. Three search approaches were used (i.e., peer-reviewed, grey literature, and forward searches) to identify studies reporting on perceptions and/or effectiveness of tools for physical activity, sedentary behaviour, and/or sleep. The quality of included studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS

In total, 135 studies reporting on 61 tools (i.e., 51 on physical activity, one on sleep, and nine combining two movement behaviours) met inclusion criteria. Included tools served the purposes of assessment (n = 57), counselling (n = 50), prescription (n = 18), and/or referral (n = 12) of one or more movement behaviour. Most tools were used or intended for use by physicians, followed by nurses/nurse practitioners (n = 11), and adults accessing care (n = 10). Most tools were also used or intended to be used with adults without chronic conditions aged 18-64 years (n = 34), followed by adults with chronic conditions (n = 18). The quality of the 116 studies that evaluated tool effectiveness varied.

CONCLUSIONS

Many tools were positively perceived and were deemed effective at enhancing knowledge of, confidence for, ability in, and frequency of movement behaviour discussions. Future tools should guide discussions of all movement behaviours in an integrated manner in line with the 24-Hour Movement Guidelines. Practically, this review offers seven evidence-based recommendations that may guide future tool development and implementation.

Comorbidities of Rural Children and Adolescents with Migraine and without Migraine

(1) Background: Migraine is associated with comorbidities that are common in the general rural pediatric population. The purpose of this study is to evaluate the differences in the occurrence of comorbidities between rural children and adolescents with and without migraine. (2) Methods: A cross-sectional, secondary data analysis using electronic medical records of 1296 patients (53.8% females, aged 12.4 ± 3.2) was completed. Mann-Whitney U test was used to detect the difference in the number of comorbidities between the two groups. Chi-square test was used to identify the differences in the number of comorbidities, which were classified as low (0-1 comorbidities), medium (2-3 comorbidities), and high (4 or plus comorbidities) degree of comorbidities. (3) Results: Significant differences were found between those children and adolescents with migraine vs. those without for depression (p < 0.0001), anxiety (p < 0.0001), and Ehlers-Danlos Syndrome (EDS; p = 0.0309). A marginally significant difference was found between those children and adolescents with migraine (47.2%; n = 306) vs. those without (42.1%; n = 273) for unhealthy weight (p = 0.0652). Approximately 40% of the migraineurs had 2-3 comorbidities, whereas 32% of the non-migraineurs had 2-3 comorbidities (p = 0.0003). (4) Conclusions: Findings demonstrate the importance of identifying comorbidities associated with rural pediatric migraine in order to develop effective treatment strategies that optimize patient outcomes.

Insomnia and Migraine: A Review of Evidence-Based, Biobehavioral Interventions

PURPOSE OF REVIEW

The purpose of this review is to discuss the current evidence for Cognitive Behavioral Therapy for Insomnia (CBT-I) for patients with migraine and comorbid insomnia. In this article, we provide a narrative review of the literature on CBT-I and migraine, highlighting recent advances in research into this topic. Finally, we propose a way for clinicians to integrate CBT-I into clinical practice.

RECENT FINDINGS

Multiple studies support CBT-I as a validated modality for the treatment of insomnia in migraine. CBT-I is used to treat insomnia and should be offered as first line therapy. Clinicians should screen for insomnia in all patients with headache, especially in those with migraine, to best manage this condition through the implementation of specific insomnia treatment.

Associations between snoring and dental sleep conditions: A systematic review

BACKGROUND

It is important for dentists to know if the presence of snoring is associated with the presence of other dental sleep conditions (e.g. obstructive sleep apnea [OSA], sleep bruxism [SB], gastroesophageal reflux disease [GERD], xerostomia and oro-facial pain). If so, dentists could play a significant role in the early recognition and management of these conditions.

OBJECTIVES

This systematic review aimed to: (i) investigate the associations between the presence of snoring and the presence of other dental sleep conditions; and (ii) determine if it is clinically relevant that dentists assess snoring in their population.

METHODS

The literature search was performed in PubMed and Embase.com in collaboration with a medical librarian. Studies were eligible if they employed regression models to assess whether snoring was associated with other dental sleep conditions, and/or investigated the incidence of snoring in patients with other dental sleep conditions and vice versa.

RESULTS

Of the 5299 retrieved references, 36 eligible studies were included. The available evidence indicates that the presence of snoring is associated with higher probabilities of OSA, GERD and headache. Due to limited evidence and conflicting findings, the currently available articles are not indicative of associations between the presence of snoring and the presence of SB and oral dryness.

CONCLUSION

Within the limitations of this study, it can be concluded that the presence of snoring is associated with higher probabilities of OSA, GERD and headache. Therefore, it is clinically relevant that dentists assess snoring in their patient population.

Migraine

Migraine affects about 1 billion people worldwide, and up to 15% of adults in the United States have migraine attacks in any given year. Migraine is associated with substantial adverse socioeconomic and personal effects. It is the second leading cause of years lived with disability worldwide for all ages and the leading cause in women aged 15 to 49 years. Diagnostic uncertainty increases the likelihood of unnecessary investigations and suboptimal management. This article advises clinicians about diagnosing migraine, ruling out secondary headache disorders, developing acute and preventive treatment plans, and deciding when to refer the patient to a specialist.

Can calcitonin gene-related peptide monoclonal antibody improve migraine and restless legs syndrome?

BACKGROUND

A significant association between migraine and restless legs syndrome (RLS) has been reported, and their coexistence is not uncommon. We report a patient with concomitant migraine and RLS who showed improvement of both migraine and RLS symptoms after treatment with galcanezumab, a calcitonin gene-related peptide (CGRP) monoclonal antibody.

CASE PRESENTATION

A 47-year-old woman had been treated in our outpatient headache clinic for migraine without aura. She had RLS since childhood and had been treated with dopamine agonists and α2δ ligands. Over the past 2 months, the patient suffered from frequent migraine headaches and worsening RLS symptoms, despite ongoing treatment. Therefore, galcanezumab was started. After 1 month, the number of headache days decreased from 20 to 4, and her score on the International RLS Study Group Rating Scale improved from 38 to 10. Her photo/phono/osmo-phobia were also markedly improved. The efficacy of galcanezumab for both headache and RLS was sustained over 5 months.

CONCLUSION

We report a case of improvement of both migraine and RLS after treatment with CGRP monoclonal antibody. Additional studies are needed to clarify how CGRP antagonism affects RLS symptoms in patients with migraine and RLS comorbidity.

Sleep Disturbances in Neurological Disease: A Target for Intervention

Sleep is a biological function required for neurological and general health, but a significant and under-recognized proportion of the population has disturbed sleep. Here, we briefly overview the biology of sleep, sleep requirements over the lifespan, and common sleep disorders. We then turn our attention to five neurological diseases that significantly contribute to global disease burden and neurology practice makeup: epilepsy, headache, ischemic stroke, Parkinson's disease, and Alzheimer's disease. For each disease, we review evidence that sleep disturbances contribute to disease risk and severity and discuss existing data that addressing sleep disturbances may have disease-modifying effects. We provide recommendations derived from the literature and existing clinical guidelines to facilitate the evaluation and management of sleep disturbances within the context of each neurological disease. Finally, we synthesize identified needs and commonalities into future directions for the field and practical sleep-related recommendations for physicians caring for patients at risk for or currently suffering from neurological disease.

Sleep and sleep-modifying factors in chronic migraine patients during the COVID-19 lockdown

Aims

The objective of the present study was to evaluate sleep features and sleep-modifying factors in patients with chronic migraine (CM) during the first Italian COVID-19 lockdown.

Material and methods

The study was based on an e-mail survey addressed to CM patients of our headache center. The survey investigated demographic, life-style, sleep, psychological, and migraine features during the first COVID-19 lockdown period and the month before. The outcomes were sleep quality (measured using PSQI) and variation in sleep quality, duration, and latency.

Results

Ninety-two patients were included. The mean PSQI was 11.96. Sleep quality was improved in 14.1%, stable in 47.8%, and worsened in 38.0%. Sleep latency was reduced in 5.4%, stable in 46.7%, and increased in 47.8%. Sleep duration was reduced in 29.3%, stable in 34.8%, and increased in 35.9%. Significant associations were found with age, work/study, remote working, job loss, meal quality change, smoking variation, COVID-19 province prevalence, home-inhabitant relationship, ratio of house size/number of people, stress, state anxiety, anxiety/depression variation, future concern variation, computer hours, internet hours, and television hours.

Conclusion

The study described sleep features of chronic migraineurs during COVID-19 lockdown, pinpointing the main factors involved in sleep quality and sleep changes. Our findings revealed that migraineurs’ sleep was closely linked with life-style and psychological features. Several modifiable factors came to light and they should be considered in order to develop an optimal management of CM. An appropriate and more aware treatment of sleep problems could be a way to improve migraineurs’ life.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10072-022-06378-0.

Association between sleep quality, migraine and migraine burden

Background

The relationship between sleep and migraine is well known to be bidirectional. However, few studies have systematically assessed the association between sleep quality and the risk of developing migraine, and its gender and age differences are unclear. And there is currently limited evidence on the associations between sleep quality and migraine-related burdens.

Objective

The objectives of this study were to: (1) explore the association between sleep quality and the risk of developing migraine, and its gender and age differences; (2) investigate the associations between sleep quality and the total pain burden, severity, disability, headache impact, quality of life, anxiety, and depression of migraine patients.

Methods

This study consecutively enrolled 134 migraine patients and 70 sex- and age-matched healthy control subjects. Sleep quality was assessed through the Pittsburgh Sleep Quality Index (PSQI). Logistic regression and linear regression analyses were used to explore the associations between sleep quality with the risk of developing migraine and the migraine-related burdens.

Results

The prevalence of poor sleep quality in migraine patients was significantly higher than that in subjects without migraine (P &lt; 0.001). After adjusting for various confounding factors, the risk of migraine with poor sleep quality remained 3.981 times that of those with good sleep quality. The subgroup analysis showed that there were significant additive interactions between poor sleep quality and the risk of migraine in gender, age, and education level (P for interaction &lt; 0.05), and the stronger correlations were found in females, populations with ages more than 35 years old, and with lower education levels. In addition, multivariate linear regression analysis showed that poor sleep quality was significantly and independently associated with the total pain burden, severity, headache impact, quality of life, anxiety, and depression in migraine patients (P trend &lt; 0.05).

Conclusion

Poor sleep quality was significantly independently associated with an increased risk of developing migraine and the migraine-related burdens. Strengthening PSQI assessment is valuable for the early prevention and treatment of migraine patients.

Headache as a Neurologic Manifestation of Systemic Disease

Purpose of Review

Recent Findings

Summary

Migraine patients visiting Chinese medicine hospital: Protocol for a prospective, registry-based, real-world observational cohort study

Introduction

Migraine is a disabling, recurrent headache disorder with complex comorbidities. Conventional treatments for migraine are unsatisfactory, with side effects and limited effectiveness. Chinese herbal medicine (CHM) has been used as an alternative or complementary treatment option for migraine in China. Currently, the existing evidence of benefit of CHM for migraine has been generated from randomised clinical trials using standardised intervention with a focus on internal validity hence with limited external validity. Moreover, CHM individualised intervention design, patients’ preferences and concerns, and clinicians’ experience are critical to clinical decision making and therapeutic success. This real-world observational study aims to gather practice-based evidence of effects and safety of CHM for migraine in the context of integrating Chinese medicine diagnostic procedures, patients’ preferences and matters relevant to clinical decision making.

Methods and analysis

The study is being undertaken at the Guangdong Provincial Hospital of Chinese Medicine (GPHCM) from December 2020 to May 2022. We anticipate that approximately 400 adult migraineurs will be enrolled and observed on their migraine severity, analgesic consumption, quality of life, anxiety, depression and insomnia at baseline and then every four weeks over 12 weeks. Treatments, diagnostic information, and patient-reported most bothersome symptoms will be collected from patient clinical records. Patient’s demographic data, preferences and concerns on CHM treatments will also be gathered at baseline and be analysed. Factors related to clinical outcomes will be explored with multiple correlation and multivariable regression analyses. Effects of CHM will be evaluated using generalised estimated equation, based on clinical outcome data.

Discussion

This study will provide comprehensive evidence of CHM for migraine in the context of evidence-based practice.

Trial registration number

ChiCTR2000041003

The relevance of migraine in the clinical spectrum of mitochondrial disorders

Recent scientific evidence suggests a link between migraine and brain energy metabolism. In fact, migraine is frequently observed in mitochondrial disorders. We studied 46 patients affected by mitochondrial disorders, through a headache-focused semi-structured interview, to evaluate the prevalence of migraine among patients affected by mitochondrial disorders, the possible correlations between migraine and neuromuscular genotype or phenotype, comorbidities, lactate acid levels and brain magnetic resonance spectroscopy. We explored migraine-related disability, analgesic and prophylactic treatments. Diagnoses were achieved according to International Classification of Headache Disorders, 3rd edition. Lifetime prevalence of migraine was 61% (28/46), with high values in both sexes (68% in females, 52% in males) and higher than the values found in both the general population and previous literature. A maternal inheritance pattern was reported in 57% of cases. MIDAS and HIT6 scores revealed a mild migraine-related disability. The high prevalence of migraine across different neuromuscular phenotypes and genotypes suggests that migraine itself may be a common clinical manifestation of brain energy dysfunction. Our results provide new relevant indications in favour of migraine as the result of brain energy unbalance.

Enhanced mindfulness-based stress reduction in episodic migraine-effects on sleep quality, anxiety, stress, and depression: a secondary analysis of a randomized clinical trial

ABSTRACT

Patients with migraine suffer from high morbidity related to the repeated headache attacks, characteristic of the disorder, poor sleep, and a high prevalence of comorbid psychosocial disorders. Current pharmacological therapies do not address these aspects of migraine, but nonpharmacological treatments such as mindfulness-based stress reduction (MBSR) have been shown to improve both pain and psychological well-being. In this secondary analysis, we examined the change over time in sleep quality and psychosocial outcomes from the magnetic resonance imaging outcomes for mindfulness meditation clinical trial and assessed how these mediated treatment response (50% reduction in headache frequency postintervention). We also examined the relationship between baseline values and treatment response. The trial (primary outcomes previously reported) included 98 patients with episodic migraine randomized to either enhanced MBSR (MBSR+) or stress management for headache. They completed psychosocial questionnaires and headache diaries at baseline (preintervention), midintervention (10 weeks after baseline), and postintervention (20 weeks after baseline). There was a significant improvement in sleep quality from baseline to postintervention (P = 0.0025) in both groups. There were no significant changes from baseline or between groups in anxiety, depression, and stress. There was also no significant association between baseline scores and treatment response. Mediation analysis showed a significant indirect effect of 6% for sleep: In other words, small improvements in sleep may have contributed to the efficacy of MBSR+.Trial registration: NCT02133209.

Behavioral Management of Episodic Migraine: Maintaining a Healthy Consistent Lifestyle

PURPOSE OF REVIEW

To describe the most recent findings related to lifestyle behaviors and migraine.

RECENT FINDINGS

An individualized conceptualization of how lifestyle factors impact migraine activity has increased our understanding of the role of behavioral interventions for episodic migraine. Healthy diets of several types have been associated with migraine attack reduction, whereas disruptions in diet like skipping meals are associated with migraine attack onset. Both aerobic activity and lower intensity yoga interventions show promise for migraine prevention. Sleep disruption has been associated with migraine day and may have a bi-directional relationship. Both increases and decreases in stress have been associated with migraine activity. Evidence is converging around the principle that highly unusual disruptions in daily routine are particularly associated with migraine attack onset and that a consistent healthy lifestyle is a key feature of effective behavioral migraine prevention strategies.

Healthy Dwelling: Design of Biophilic Interior Environments Fostering Self-Care Practices for People Living with Migraines, Chronic Pain, and Depression

The benefits of biophilic interior design have been recognized by healthcare facilities, but residential environments receive relatively less attention with respect to improving the health of people living with chronic diseases. Recent “stay-at-home” restrictions due to the COVID-19 pandemic further emphasized the importance of creating interior spaces that directly and indirectly support physical and mental health. In this viewpoint article, we discuss opportunities for combining biophilic interventions with interior design, fostering disease-specific self-care. We provide examples of designing residential spaces integrating biophilic interventions, light therapy, relaxation opportunities, mindfulness meditation, listening to music, physical activities, aromatherapy, and quality sleep. These modalities can provide the clinical benefits of reducing migraine headaches and chronic pain, as well as improving depressive symptoms. The disease-specific interior environment can be incorporated into residential homes, workplaces, assisted-living residences, hospitals and hospital at home programs. This work aims to promote a cross-disciplinary dialogue towards combining biophilic design and advances in lifestyle medicine to create therapeutic interior environments and to improve healthcare outcomes.

Current Perspectives on the Impact of Chronic Migraine on Sleep Quality: A Literature Review

OBJECTIVE

Recent studies have shown that sleep problems occur in migraineurs and poor sleep causes chronification, but the mechanisms by which chronic migraine affects sleep quality are still unknown. This review aims to analyze commonly reported sleep disturbances in chronic migraine (CM) and determine the effect of CM on sleep quality.

MATERIALS AND METHODS

We conducted a comprehensive review of all published articles on CM and sleep quality from inception to March 2022 in the literature. Clinical trials, observational studies, and case series (≥20 cases) were included. Two reviewers and a supervisor reviewed the titles and abstracts of all search results with predefined inclusion and exclusion criteria. PubMed search for randomized controlled trials and open studies on CM and sleep quality reported in English between 1983 and 2022 was conducted using the keywords including chronic migraine, sleep, insomnia, sleep quality, polysomnography, and Pittsburgh Sleep Quality Index.

RESULTS

A total of 535 potentially relevant articles were found. A total of 455 articles and reviews, meta-analyses published in any language other than English, with other exclusion criteria, were excluded from the review. In the remaining articles, 36 clinical studies, reviewing sleep quality and its association with migraine, were identified and reviewed. Evidence from this review shows that poor sleep and migraine chronicity are intertwined with other accompanying comorbidities and dysregulation of circadian rhythm that innovative treatments promise to bring relief to both poor sleep as well as migraine.

CONCLUSION

Sleep disorders are common in CM and the association between migraine chronification and sleep quality is bidirectional. Comorbid conditions with accompanying frequent attacks in migraine may impair sleep quality. While the maladaptive pain process worsens sleep, poor sleep quality also negatively affects migraine pain. Sleep disturbance, which is affected by worsening migraine attacks, causes deterioration in the quality of life, loss of workforce, and economic burden.

How to Assess the Headache-Sleep Disorders Comorbidity in Children and Adolescents

Sleep disorders and primary headaches are frequent health problems in childhood, and they are often comorbid in an individual, linked by a mutual and complex relationship. This comorbidity is frequent and well-documented, but the available literature is usually biased in favor of one aspect or another, mainly depending on the expertise of the authors. The aim of this paper is to review existing literature on the diagnostic assessment of comorbid primary headaches and sleep disorders, so as to propose practical suggestions to accurately investigate the presence of comorbid conditions in children evaluated for primary headaches or for sleep disorders.

Is there any association between migraine headache and polycystic ovary syndrome (PCOS)? A review article

BACKGROUND

Polycystic ovary syndrome (PCOS) and migraine headaches are considered to be common health problems that may share some risk factors. This study aimed to discuss the possible association between migraine headache and polycystic ovary syndrome.

METHODS AND RESULTS

In this narrative review, PubMed, Scopus, Web of Science, and Google Scholar were systematically searched for retrieving and summarizing published studies up to January 2021 to explore the possible interplay between migraine headache and PCOS. We discuss the possible pathways that may explain the association between migraine headaches and PCOS signs/symptoms and complications. While genetic factors have profound effects on the pathogenesis of migraine headaches, sex hormones, including estrogen and progesterone may also play an important role in inducing migraine headaches. Some disorders, such as sleep apnea, amenorrhea, and vascular disease that are more likely to occur in women with PCOS, may cause or exacerbate migraine headaches in women with PCOS.

CONCLUSIONS

Future comprehensive studies are needed to investigate the exact underlining mechanisms related to the association between PCOS and migraine headaches.

Migraine: beyond pain

Most people who see, treat or experience migraine will be aware that its clinical manifestations exceed the symptom of head pain. However, available acute treatments so far have targeted migraine symptoms only in the context of the pain phase of an attack. The associated disability clearly involves more than just these symptoms, and the phenotype can include additional painless features, including alterations in mood, cognition and homeostasis and sensory sensitivities. Recognising these symptoms, understanding their neurobiological basis and systematically recording them prospectively in clinical therapeutic trials are likely to offer valuable pathophysiological and therapeutic insights into this complex brain disorder, ultimately helping to improve the quality of lives of sufferers. We aim to explore the multifaceted disorder that is migraine, with a particular focus on the non-painful non-aura symptoms.

Nightmares in Migraine: A Focused Review

Nightmares usually occur during the sleep phase of rapid eye movement (REM) and are associated with some physical symptoms, including sweating, shortness of breath, and lower limb movements. Emotions of fear, anger, shame, and sadness may also accompany nightmares. These symptoms can occur during dreaming, upon awakening, or later when the dream experience is recollected. Nightmares may sporadically occur for everyone, but nightmare disorders are associated with features of impaired mental and physical health and require professional medical treatment. The occurrence of nightmares with several disorders has been reported in the literature, but in migraines it has only been investigated in a small number of studies. Considering the existing relationship between sleep disorders and migraine, the occurrence of nightmares in migraine can negatively affect this association and elevate the risk of depression and anxiety. This, in turn, further reduces the quality of life of affected individuals. Hence, expanding the knowledge on the link between nightmares and migraine, promoting an acceptable quantity and quality of sleep through pharmacological and nonpharmacological interventions in the management of nightmares in migraine, and further scientific investigation of the biopsychosocial mechanisms underlying the link, will be highly valuable for optimal care. This focused review, therefore, gives a brief overview of the current understanding of nightmares in migraine to highlight the open questions and value of further research. The ultimate goal is to contribute to timely recognition and sufficient action to offer beneficial outcomes for affected patients.

Sleep Disorders in Pediatric Migraine: A Questionnaire-Based Study

There is a high comorbidity between migraine and sleep disorders (SD), with a mutual dependence between sleep and headache. This study aimed to analyze the relationship between headache features (migraine frequency and severity, migraine equivalents, use and efficacy of treatments) and sleep in pediatric migraine. Parents of children and adolescents with migraine completed the Children’s Sleep Habits Questionnaire (CSHQ) and the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) and answered questions about headache characteristics. The presence of SD was defined according to CSHQ score. SD were detected in 72.9% of 140 subjects, but only 5.0% already received a diagnosis. Patients with SD presented statistically significant higher headache frequency (p = 0.031) and higher prevalence of migraine equivalents (p = 0.007). A higher CSHQ total score was associated with higher frequency of severe attacks (p = 0.012) and lower acute drug efficacy (p = 0.003). Significant positive correlations of sleep onset delay, sleep duration and nightwakings subscales with migraine frequency emerged. Our findings indicate that SD are highly prevalent in pediatric migraine and frequently associated with a higher headache severity and lower response to acute therapy, but often remain underdiagnosed. Improving sleep quality could help to reduce migraine intensity and disability and vice versa.

Sleep in Neurologic Disorders

Sleep is a complex brain state with fundamental relevance for cognitive functions, synaptic plasticity, brain resilience, and autonomic balance. Sleep pathologies may interfere with cerebral circuit organization, leading to negative consequences and favoring the development of neurologic disorders. Conversely, the latter can interfere with sleep functions. Accordingly, assessment of sleep quality is always recommended in the diagnosis of patients with neurologic disorders and during neurorehabilitation programs. This review investigates the complex interplay between sleep and brain pathologies, focusing on diseases in which the association with sleep disturbances is commonly overlooked and whereby major benefits may derive from their proper management.

Migraine Is More Than Just Headache: Is the Link to Chronic Fatigue and Mood Disorders Simply Due to Shared Biological Systems?

Migraine is a symptomatically heterogeneous condition, of which headache is just one manifestation. Migraine is a disorder of altered sensory thresholding, with hypersensitivity among sufferers to sensory input. Advances in functional neuroimaging have highlighted that several brain areas are involved even prior to pain onset. Clinically, patients can experience symptoms hours to days prior to migraine pain, which can warn of impending headache. These symptoms can include mood and cognitive change, fatigue, and neck discomfort. Some epidemiological studies have suggested that migraine is associated in a bidirectional fashion with other disorders, such as mood disorders and chronic fatigue, as well as with other pain conditions such as fibromyalgia. This review will focus on the literature surrounding alterations in fatigue, mood, and cognition in particular, in association with migraine, and the suggested links to disorders such as chronic fatigue syndrome and depression. We hypothesize that migraine should be considered a neural disorder of brain function, in which alterations in aminergic networks integrating the limbic system with the sensory and homeostatic systems occur early and persist after headache resolution and perhaps interictally. The associations with some of these other disorders may allude to the inherent sensory sensitivity of the migraine brain and shared neurobiology and neurotransmitter systems rather than true co-morbidity.

Positive airway pressure therapy for chronic pain in patients with obstructive sleep apnea-a systematic review

PURPOSE

Obstructive sleep apnea (OSA) is prevalent in patients with chronic non-cancer pain. OSA may lead to low sleep quality and an increase in pain sensitivity. Patients reporting greater sleep impairment tend to experience higher pain intensity and vice versa. Positive airway pressure (PAP) is the current gold standard treatment for OSA. This review aims to evaluate the efficacy of PAP therapy in patients with comorbid chronic pain and OSA in influencing pain outcomes like pain intensity, tolerance, threshold, and sensitivity.

METHODS

We performed a systematic literature search for studies published after 1990, utilizing the following databases: Medline, Medline In-Process/ePubs, Embase, Cochrane CENTRAL, and the Cochrane Database of Systematic Reviews. Search terms included "chronic pain," "sleep disorders," and "positive airway pressure."

RESULTS

Of 1982 initial studies, ten studies met the study inclusion criteria. Seven of these studies examined the effect of PAP therapy on chronic pain, of which five demonstrated improved pain outcomes, specifically, headache pain. The effect of PAP therapy on chronic non-headache pain was found to be inconclusive. When examining the three studies that did not involve chronic pain patients, PAP therapy effectively increased pain threshold and tolerance in two studies (p = 0.03 and p = 0.01).

CONCLUSION

An association exists between PAP therapy and decreased chronic headache outcomes in patients with OSA. Additionally, research shows that PAP therapy may increase pain tolerance and threshold. Future high-quality evidence is required to further investigate the association between PAP and non-headache chronic pain.

Obesity, Migraine, and Overlapping Comorbidities in a Rural Pediatric Population

Objective  This study aims to report the prevalence of obesity and overlapping comorbidities in a rural population of children and adolescents with migraine. Design and Methods  A cross-sectional, descriptive, secondary data analysis using a comprehensive patient database from the West Virginia University (WVU) Medicine Epic Clarity system will be reported. A review of electronic medical records of 990 children and adolescents, ages 7 to 17 years, evaluated for headache at a rural clinic from December 1, 2009 to December 31, 2017 was completed. The Chi-square test was used to identify any differences in demographic characteristics (age, gender, and race) and distribution of comorbidities (obstructive sleep apnea syndrome [OSAS], depression, and anxiety) among obese versus nonobese adolescents with migraine. Student's t -test was used to identify any differences in the number of comorbidities between the two groups. Results  A total of 648 children and adolescents with a diagnosis of migraine were identified. Approximately 26.4% of the children and adolescents diagnosed with migraine ( n = 648) met the criteria for being obese with a mean body mass index (BMI) of 30.6 kg/m ² (standard deviation [SD] = 6.5), ranging from 20.0 to 58.5 kg/m ² . There were no significant differences between migraineurs who were categorized as obese versus nonobese in terms of gender ( p = 0.8587), age ( p = 0.1703), race ( p = 0.7655), anxiety ( p = 0.1841), or depression ( p = 0.2793). Obese individuals have more comorbidities than nonobese individuals ( p = 0.015). Additionally, the prevalence of OSAS was significantly higher among obese versus nonobese migraineurs (20 vs. 9.9%, p = 0.0007). Conclusion  Given the prevalence of obesity in rural pediatric populations and the reported neurobiological links between migraine and obesity, BMI needs to be monitored and weight management interventions included in plans of care for rural children and adolescents with migraine.

Effects of aromatherapy on sleep disorders: A protocol for systematic review and meta-analysis

BACKGROUND

The progress of modern society and changes in lifestyle have not only increased the proportion of sub-healthy people, but also caused many people to suffer from sleep disorders and mental anxiety. Long-term lack of high-quality sleep will not only cause psychological problems such as anxiety and fatigue, but also cause physical abnormalities, such as abnormal hormone secretion, weakened immunity, neuroendocrine disorders, and high blood pressure. Therefore, the purpose of this study is to systematically evaluate the effectiveness of aromatherapy in improving sleep quality in people with sleep disorders.

METHODS

Computer search CNKI, SinoMed, Wanfang, PubMed, Web of science, and EMbase collect randomized controlled trials on aromatherapy to improve sleep quality of people with sleep disorders. The search time limit is to build the database until April 5, 2021. RevMan5.3 software is used for meta-analysis.

RESULTS

This systematic review will provide an assessment of the current state of sleep disorders, aiming to assess the efficacy of aromatherapy for patients with sleep disorders.

CONCLUSION

This systematic review will provide a credible evidence-based for the clinical treatment of sleep disorders with aromatherapy.

Pathophysiological Bases of Comorbidity in Migraine

Despite that it is commonly accepted that migraine is a disorder of the nervous system with a prominent genetic basis, it is comorbid with a plethora of medical conditions. Several studies have found bidirectional comorbidity between migraine and different disorders including neurological, psychiatric, cardio- and cerebrovascular, gastrointestinal, metaboloendocrine, and immunological conditions. Each of these has its own genetic load and shares some common characteristics with migraine. The bidirectional mechanisms that are likely to underlie this extensive comorbidity between migraine and other diseases are manifold. Comorbid pathologies can induce and promote thalamocortical network dysexcitability, multi-organ transient or persistent pro-inflammatory state, and disproportionate energetic needs in a variable combination, which in turn may be causative mechanisms of the activation of an ample defensive system with includes the trigeminovascular system in conjunction with the neuroendocrine hypothalamic system. This strategy is designed to maintain brain homeostasis by regulating homeostatic needs, such as normal subcortico-cortical excitability, energy balance, osmoregulation, and emotional response. In this light, the treatment of migraine should always involves a multidisciplinary approach, aimed at identifying and, if necessary, eliminating possible risk and comorbidity factors.

Comprehensive Overview of Sleep Disorders in Patients with Chronic Liver Disease

The impact of sleep disorders (SDs) on patients with chronic liver diseases (CLD) is tremendous. SDs are frequently encountered among these patients and interfere with their quality of life. This review aims to present the data available so far about the prevalence, phenotypes, and proposed pathophysiological mechanisms of SDs in CLD. Moreover, we proposed to search the literature regarding the most reliable methods to assess SDs and the possible therapeutic options in patients with CLD. The main results of this review show that when it comes to prevalence, the percentages reported vary widely between studies performed among populations from the USA or Europe and those coming from Asian countries. Furthermore, it has been proven that SDs may also be present in the absence of neurocognitive disorders attributable to hepatic encephalopathy (HE), which contradicts traditional suppositions where SDs were considered part of the clinical scenario of HE. Currently, there are no specific recommendations or protocols to assess SDs in CLD patients and data about the therapeutic management are limited. Taking into consideration their impact, a protocol for diagnosing and managing SDs should be developed and included in the daily practice of hepatologists.

Lasmiditan in patients with common migraine comorbidities: a post hoc efficacy and safety analysis of two phase 3 randomized clinical trials

OBJECTIVE

Determine whether common migraine comorbidities affect the efficacy and safety of lasmiditan, a 5-HT_1F receptor agonist approved in the United States for the acute treatment of migraine.

METHODS

In SPARTAN and SAMURAI (double-blind Phase 3 clinical trials), patients with migraine were randomized to oral lasmiditan 50 mg (SPARTAN only), 100mg, 200 mg, or placebo. Lasmiditan increased the proportion of pain-free and most bothersome symptom (MBS)-free patients at 2 h after dose compared with placebo. Most common treatment-emergent adverse events (TEAEs) were dizziness, paraesthesia, somnolence, fatigue, nausea, muscular weakness, and hypoesthesia. Based upon literature review of common migraine comorbidities, Anxiety, Allergy, Bronchial, Cardiac, Depression, Fatigue, Gastrointestinal, Hormonal, Musculoskeletal/Pain, Neurological, Obesity, Sleep, and Vascular Comorbidity Groups were created. Using pooled results, efficacy and TEAEs were assessed to compare patients with or without a given common migraine comorbidity. To compare treatment groups, p-values were calculated for treatment-by-subgroup interaction, based on logistic regression with treatment-by-comorbidity condition status (Yes/No) as the interaction term; study, treatment group, and comorbidity condition status (Yes/No) were covariates. Differential treatment effect based upon comorbidity status was also examined. Trial registration at clinicaltrials.gov: SAMURAI (NCT02439320) and SPARTAN (NCT02605174).

RESULTS

Across all the Comorbidity Groups, with the potential exception of fatigue, treatment-by-subgroup interaction analyses did not provide evidence of a lasmiditan-driven lasmiditan versus placebo differential treatment effect dependent on Yes versus No comorbidity subgroup for either efficacy or TEAE assessments.

CONCLUSIONS

The efficacy and safety of lasmiditan for treatment of individual migraine attacks appear to be independent of comorbid conditions.